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Atici AE, Noval Rivas M, Arditi M. The Central Role of Interleukin-1 Signalling in the Pathogenesis of Kawasaki Disease Vasculitis: Path to Translation. Can J Cardiol 2024:S0828-282X(24)00581-6. [PMID: 39084253 DOI: 10.1016/j.cjca.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
Kawasaki disease (KD) manifests as an acute febrile condition and systemic vasculitis, the etiology of which remains elusive. Primarily affecting children under 5 years of age, if untreated KD can lead to a significant risk of coronary artery aneurysms and subsequent long-term cardiovascular sequelae, including myocardial ischemia and myocardial infarction. Intravenous immunoglobulin therapy mitigates the risk of aneurysm formation, but a subset of patients exhibit resistance to this treatment, increasing the susceptibility of coronary artery lesions. Furthermore, the absence of a KD-specific diagnostic test or biomarkers complicates early detection and appropriate treatment. Experimental murine models of KD vasculitis have substantially improved our understanding of the disease pathophysiology, revealing the key roles of the NLRP3 inflammasome and interleukin-1 (IL-1) signalling pathway. This review aims to delineate the pathophysiologic findings of KD while summarising the findings for the emerging key role of IL-1β in its pathogenesis, derived from both human data and experimental murine models, and the translational potential of these findings for anti-IL-1 therapies for children with KD.
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Affiliation(s)
- Asli Ekin Atici
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California, USA; Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Magali Noval Rivas
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California, USA; Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moshe Arditi
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California, USA; Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Amorim-Figueiredo R, Pereira Lemos A, Rito T, Conde M, Brito MJ, Pinto F. Multiresistant Kawasaki Disease in a Young Infant with Giant Aneurysms Growing Fast. J Cardiovasc Dev Dis 2024; 11:149. [PMID: 38786971 PMCID: PMC11122641 DOI: 10.3390/jcdd11050149] [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: 03/16/2024] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a type of vasculitis in which giant coronary artery aneurysms (CAAs) can occur. There are no specific guidelines for managing giant CAAs that develop quickly and are at risk of rupture. Regarding cardiovascular drugs, only beta-blockers are formally recommended in the acute phase of KD. CASE PRESENTATION A 6-month-old male patient with multiresistant Kawasaki disease and giant CAAs that continued to enlarge after controlling systemic inflammation was examined. The patient required three doses of intravenous immunoglobulin, methylprednisolone pulses, and anakinra and infliximab to normalize systemic inflammation. Due to the rapid increment of aneurysms' dimensions and the risk of rupture, we introduced anticoagulant therapy and propranolol plus captopril, and titration doses were introduced according to a tolerated decrease in heart rate and arterial pressure. CAAs increment stabilized and slowly reduced their dimensions. CONCLUSIONS The authors describe an atypical case of multiresistant KD with giant rapidly increasing CAAs even after controlling systemic inflammation. The introduction of a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor was demonstrated to be useful for stabilizing giant CAAs growth and reducing the potential risk of rupture.
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Affiliation(s)
- Rosa Amorim-Figueiredo
- Pediatric Infectious Diseases Unit, Dona Estefânia Hospital, Unidade Local de Saúde São José, Academic Clinical Centre of Lisbon, 1169-045 Lisbon, Portugal; (A.P.L.); (M.J.B.)
| | - Ana Pereira Lemos
- Pediatric Infectious Diseases Unit, Dona Estefânia Hospital, Unidade Local de Saúde São José, Academic Clinical Centre of Lisbon, 1169-045 Lisbon, Portugal; (A.P.L.); (M.J.B.)
| | - Tiago Rito
- Department of Pediatric Cardiology and Reference Center for Congenital Heart Diseases, Santa Marta Hospital, Unidade Local de Saúde São José, Academic Clinical Centre of Lisbon, 1169-024 Lisbon, Portugal; (T.R.); (F.P.)
- European Reference Network for Rare, Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), 1169-024 Lisbon, Portugal
| | - Marta Conde
- Pediatric Rheumatology Unit, Dona Estefânia Hospital, Unidade Local de Saúde São José, Academic Clinical Centre of Lisbon, 1169-045 Lisbon, Portugal;
| | - Maria João Brito
- Pediatric Infectious Diseases Unit, Dona Estefânia Hospital, Unidade Local de Saúde São José, Academic Clinical Centre of Lisbon, 1169-045 Lisbon, Portugal; (A.P.L.); (M.J.B.)
| | - Fátima Pinto
- Department of Pediatric Cardiology and Reference Center for Congenital Heart Diseases, Santa Marta Hospital, Unidade Local de Saúde São José, Academic Clinical Centre of Lisbon, 1169-024 Lisbon, Portugal; (T.R.); (F.P.)
- European Reference Network for Rare, Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), 1169-024 Lisbon, Portugal
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Zhang J, Huang H, Xu L, Wang S, Gao Y, Zhuo W, Wang Y, Zheng Y, Tang X, Jiang J, Lv H. Knowledge framework of intravenous immunoglobulin resistance in the field of Kawasaki disease: A bibliometric analysis (1997-2023). Immun Inflamm Dis 2024; 12:e1277. [PMID: 38775687 PMCID: PMC11110715 DOI: 10.1002/iid3.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an autoimmune disease with cardiovascular disease as its main complication, mainly affecting children under 5 years old. KD treatment has made tremendous progress in recent years, but intravenous immunoglobulin (IVIG) resistance remains a major dilemma. Bibliometric analysis had not been used previously to summarize and analyze publications related to IVIG resistance in KD. This study aimed to provide an overview of the knowledge framework and research hotspots in this field through bibliometrics, and provide references for future basic and clinical research. METHODS Through bibliometric analysis of relevant literature published on the Web of Science Core Collection (WoSCC) database between 1997 and 2023, we investigated the cooccurrence and collaboration relationships among countries, institutions, journals, and authors and summarized key research topics and hotspots. RESULTS Following screening, a total of 364 publications were downloaded, comprising 328 articles and 36 reviews. The number of articles on IVIG resistance increased year on year and the top three most productive countries were China, Japan, and the United States. Frontiers in Pediatrics had the most published articles, and the Journal of Pediatrics had the most citations. IVIG resistance had been studied by 1889 authors, of whom Kuo Ho Chang had published the most papers. CONCLUSION Research in the field was focused on risk factors, therapy (atorvastatin, tumor necrosis factor-alpha inhibitors), pathogenesis (gene expression), and similar diseases (multisystem inflammatory syndrome in children, MIS-C). "Treatment," "risk factor," and "prediction" were important keywords, providing a valuable reference for scholars studying this field. We suggest that, in the future, more active international collaborations are carried out to study the pathogenesis of IVIG insensitivity, using high-throughput sequencing technology. We also recommend that machine learning techniques are applied to explore the predictive variables of IVIG resistance.
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Affiliation(s)
- Jiaying Zhang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Hongbiao Huang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
- Department of PediatricsFujian Province HospitalFuzhouFujianChina
| | - Lei Xu
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Shuhui Wang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yang Gao
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Wenyu Zhuo
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yan Wang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yiming Zheng
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xuan Tang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Jiaqi Jiang
- Department of Pediatrics, No.2 Affiliated HospitalAir Force Medical UniversityXianShanxiChina
| | - Haitao Lv
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
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Bossi G, Codazzi AC, Vinci F, Clerici E, Regalbuto C, Crapanzano C, Veraldi D, Moiraghi A, Marseglia GL. Efficacy of Anakinra on Multiple Coronary Arteries Aneurysms in an Infant with Recurrent Kawasaki Disease, Complicated by Macrophage Activation Syndrome. CHILDREN 2022; 9:children9050672. [PMID: 35626849 PMCID: PMC9139195 DOI: 10.3390/children9050672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/16/2022]
Abstract
Kawasaki disease (KD) is rare in infants less than 3 months of age, and its recurrence is exceptional. Infants with KD are at higher risk of severe clinical presentation, therapy failure, complications and coronary aneurysms (CAAs), and this is the reason they deserve more aggressive therapy and a strict clinical follow-up. We report a 2-month-old male with KD, complicated by Macrophage Activation Syndrome (MAS). Despite timely and aggressive therapy with immunoglobulins, steroids and aspirin, multiple CAAs developed. Two-month therapy with anakinra completely reverted all the aneurysms. After six months, the infant experienced KD relapse and was successfully re-treated with immunoglobulins, steroids and aspirin. A strict echocardiographic follow-up did not show recurrence of aneurysms. Two years later, the child is healthy, without cardiac sequelae. In our experience, anakinra was effective in reverting multiple aneurysms and its effect proved to be long-lasting, even in front of KD recurrence. Based on this evidence, it seems reasonable to hypothesize not to limit the use of anakinra as rescue therapy for complicated or refractory KD, but to consider the possibility of adding it to first-line therapies for some subgroups of very-high-risk patients, in order to strengthen the prevention of CAAs.
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Affiliation(s)
- Grazia Bossi
- Department of Pediatrics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence:
| | - Alessia Claudia Codazzi
- Pediatric Cardiology, Department of Pediatrics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, 27100 Pavia, Italy;
| | - Federica Vinci
- Pediatric School of Specialization, University of Pavia, 27100 Pavia, Italy; (F.V.); (E.C.); (C.R.); (C.C.); (D.V.); (A.M.)
| | - Edoardo Clerici
- Pediatric School of Specialization, University of Pavia, 27100 Pavia, Italy; (F.V.); (E.C.); (C.R.); (C.C.); (D.V.); (A.M.)
| | - Corrado Regalbuto
- Pediatric School of Specialization, University of Pavia, 27100 Pavia, Italy; (F.V.); (E.C.); (C.R.); (C.C.); (D.V.); (A.M.)
| | - Carmela Crapanzano
- Pediatric School of Specialization, University of Pavia, 27100 Pavia, Italy; (F.V.); (E.C.); (C.R.); (C.C.); (D.V.); (A.M.)
| | - Daniele Veraldi
- Pediatric School of Specialization, University of Pavia, 27100 Pavia, Italy; (F.V.); (E.C.); (C.R.); (C.C.); (D.V.); (A.M.)
| | - Alice Moiraghi
- Pediatric School of Specialization, University of Pavia, 27100 Pavia, Italy; (F.V.); (E.C.); (C.R.); (C.C.); (D.V.); (A.M.)
| | - Gian Luigi Marseglia
- Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
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Yang J, Jain S, Capparelli EV, Best BM, Son MB, Baker A, Newburger JW, Franco A, Printz BF, He F, Shimizu C, Hoshino S, Bainto E, Moreno E, Pancheri J, Burns JC, Tremoulet AH. Anakinra Treatment in Patients with Acute Kawasaki Disease with Coronary Artery Aneurysms: A Phase I/IIa Trial. J Pediatr 2022; 243:173-180.e8. [PMID: 34953816 DOI: 10.1016/j.jpeds.2021.12.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine the safety, pharmacokinetics, and immunomodulatory effects of 2-6 weeks of anakinra therapy in patients with acute Kawasaki disease with a coronary artery aneurysm (CAA). STUDY DESIGN We performed a Phase I/IIa dose-escalation study of anakinra (2-11 mg/kg/day) in 22 patients with acute Kawasaki disease with CAA. We measured interleukin (IL)-1RA concentrations after the first dose and trough levels up to study week 6. Markers of inflammation and coronary artery z-scores were assessed pretreatment and at 48 hours, 2 weeks, and 6 weeks after initiation of therapy. RESULTS Up to 6 weeks of anakinra (up to 11 mg/kg/day) was safe and well tolerated by the 22 participants (median age, 1.1 years), with no serious adverse events attributable to the study drug. All participants were treated with intravenous immunoglobulin (IVIG), and 20 also received infliximab (10 mg/kg) before initiation of anakinra. Serum levels of IL-6, IL-8, and tumor necrosis factor α decreased similarly in patients with Kawasaki disease treated with IVIG, infliximab, and anakinra compared with age- and sex-matched patients with Kawasaki disease treated only with IVIG and infliximab. Anakinra clearance increased with illness day at diagnosis. Simulations demonstrated that more frequent intravenous (IV) dosing may result in more sustained concentrations without significantly increasing the peak concentration compared with subcutaneous (SC) dosing. CONCLUSIONS Both IV and SC anakinra are safe in infants and children with acute Kawasaki disease and CAA. IV dosing every 8-12 hours during the acute hospitalization of patients with Kawasaki disease may result in a sustained concentration while avoiding frequent SC injections. The efficacy of a short course of IV therapy during hospitalization should be studied. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02179853.
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Affiliation(s)
- Jincheng Yang
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | - Edmund V Capparelli
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
| | - Brookie M Best
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
| | - Mary Beth Son
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Annette Baker
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Alessandra Franco
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Beth F Printz
- Division of Pediatric Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Feng He
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | - Chisato Shimizu
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Shinsuke Hoshino
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Emelia Bainto
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Elizabeth Moreno
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Joan Pancheri
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Jane C Burns
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | - Adriana H Tremoulet
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA.
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Buda P, Friedman-Gruszczyńska J, Książyk J. Anti-inflammatory Treatment of Kawasaki Disease: Comparison of Current Guidelines and Perspectives. Front Med (Lausanne) 2021; 8:738850. [PMID: 34917629 PMCID: PMC8669475 DOI: 10.3389/fmed.2021.738850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/04/2021] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD), an acute, generalized vasculitis, is associated with an increased risk of coronary heart disease and is the most common cause of acquired heart disease in childhood. The incidence of KD is increasing worldwide. There are numerous international treatment guidelines. Our study aims to perform the first one so far comparison of them. While the gold standard therapy remains still the same (intravenous immunoglobulins and aspirin), there is currently a lack of evidence for choosing optimal treatment for high-risk patients and refractory KD. In this review, we also discuss the treatment of complications of KD and Kawasaki-like phenotypes, present an anti-inflammatory treatment in the light of new scientific data, and present novel potential therapeutic targets for KD.
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Affiliation(s)
- Piotr Buda
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
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Meng L, Zhen Z, Jiang Q, Li XH, Yuan Y, Yao W, Zhang MM, Li AJ, Shi L. Predictive model based on gene and laboratory data for intravenous immunoglobulin resistance in Kawasaki disease in a Chinese population. Pediatr Rheumatol Online J 2021; 19:95. [PMID: 34174887 PMCID: PMC8236184 DOI: 10.1186/s12969-021-00582-6] [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: 10/26/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Here, we investigated the predictive efficiency of a newly developed model based on single nucleotide polymorphisms (SNPs) and laboratory data for intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD) in a Chinese population. METHODS Data relating to children with KD were acquired from a single center between December 2015 and August 2019 and used to screen target SNPs. We then developed a predictive model of IVIG resistance using previous laboratory parameters. We then validated our model using data acquired from children with KD attending a second center between January and December 2019. RESULTS Analysis showed that rs10056474 GG, rs746994GG, rs76863441GT, rs16944 (CT/TT), and rs1143627 (CT/CC), increased the risk of IVIG-resistance in KD patients (odds ratio, OR > 1). The new predictive model, which combined SNP data with a previous model derived from laboratory data, significantly increased the area under the receiver-operator-characteristic curves (AUC) (0.832, 95% CI: 0.776-0.878 vs 0.793, 95%CI:0.734-0.844, P < 0.05) in the development dataset, and (0.820, 95% CI: 0.730-0.889 vs 0.749, 95% CI: 0.652-0.830, P < 0.05) in the validation dataset. The sensitivity and specificity of the new assay were 65.33% (95% CI: 53.5-76.0%) and 86.67% (95% CI: 80.2-91.7%) in the development dataset and 77.14% (95% CI: 59.9-89.6%) and 86.15% (95% CI: 75.3-93.5%) in the validation dataset. CONCLUSION Analysis showed that rs10056474 and rs746994 in the SMAD5 gene, rs76863441 in the PLA2G7 gene, and rs16944 or rs1143627 in the interleukin (IL)-1B gene, were associated with IVIG resistant KD in a Chinese population. The new model combined SNPs with laboratory data and improved the predictve efficiency of IVIG-resistant KD.
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Affiliation(s)
- Li Meng
- grid.418633.b0000 0004 1771 7032Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China ,grid.459434.bDepartment of Cardiology, Children’s Hospital Capital Institute of Pediatrics, No. 2 Ya-Bao Road, Chao Yang District, Beijing, 100020 China
| | - Zhen Zhen
- grid.24696.3f0000 0004 0369 153XDepartment of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Qian Jiang
- grid.418633.b0000 0004 1771 7032Department of Genetics, Capital Institute of Pediatrics, Beijing, China
| | - Xiao-hui Li
- grid.418633.b0000 0004 1771 7032Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China ,grid.459434.bDepartment of Cardiology, Children’s Hospital Capital Institute of Pediatrics, No. 2 Ya-Bao Road, Chao Yang District, Beijing, 100020 China
| | - Yue Yuan
- grid.24696.3f0000 0004 0369 153XDepartment of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wei Yao
- grid.459434.bDepartment of Cardiology, Children’s Hospital Capital Institute of Pediatrics, No. 2 Ya-Bao Road, Chao Yang District, Beijing, 100020 China
| | - Ming-ming Zhang
- grid.459434.bDepartment of Cardiology, Children’s Hospital Capital Institute of Pediatrics, No. 2 Ya-Bao Road, Chao Yang District, Beijing, 100020 China
| | - Ai-jie Li
- grid.459434.bDepartment of Cardiology, Children’s Hospital Capital Institute of Pediatrics, No. 2 Ya-Bao Road, Chao Yang District, Beijing, 100020 China
| | - Lin Shi
- grid.459434.bDepartment of Cardiology, Children’s Hospital Capital Institute of Pediatrics, No. 2 Ya-Bao Road, Chao Yang District, Beijing, 100020 China
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8
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Mastrolia MV, Abbati G, Signorino C, Maccora I, Marrani E, Pagnini I, Simonini G. Early anti IL-1 treatment replaces steroids in refractory Kawasaki disease: clinical experience from two case reports. Ther Adv Musculoskelet Dis 2021; 13:1759720X211002593. [PMID: 33854568 PMCID: PMC8010843 DOI: 10.1177/1759720x211002593] [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: 01/05/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
Refractory Kawasaki disease (KD) is related to a major risk of coronary arteries abnormalities and its treatment is not standardized. In this regard, anakinra (ANA), an interleukin (IL)-1 receptor antagonist, represents an emerging therapeutic option. We report two cases of children, diagnosed with KD, nonresponsive to two doses of intravenous immunoglobulins, successfully treated with ANA, without a prior use of steroids. Patient 2 developed a coronary dilatation, that improved significantly after ANA therapy. Our experience highlights IL-1 blockade effectiveness in reducing KD inflammation and suggests ANA adoption as second-line therapy, with a timesaving and steroid-sparing strategy. Our results, combined with the evidence of the IL-1 key role in KD and coronary arteritis pathogenesis and to the recent clinical evidence reported by the KAWAKINRA trial, encourage an earlier recourse to ANA in patients with refractory KD, in order to fight inflammation, and to treat and prevent the development of coronary artery aneurysms. Further studies are needed to better define the place of IL-1 blockade in KD step-up treatment.
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Affiliation(s)
| | - Giulia Abbati
- Pediatric Residency, Meyer Children's University Hospital, University of Florence, Firenze, Italy
| | - Claudia Signorino
- Pediatric Residency, Meyer Children's University Hospital, University of Florence, Firenze, Italy
| | - Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Gabriele Simonini
- NEUROFARBA Department, University of Florence, Rheumatology Unit, Meyer Children's University Hospital, Florence, Viale Gaetano Pieraccini, 24, Firenze, 50139, Italy
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9
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Maruyama D, Kocatürk B, Lee Y, Abe M, Lane M, Moreira D, Chen S, Fishbein MC, Porritt RA, Noval Rivas M, Arditi M. MicroRNA-223 Regulates the Development of Cardiovascular Lesions in LCWE-Induced Murine Kawasaki Disease Vasculitis by Repressing the NLRP3 Inflammasome. Front Pediatr 2021; 9:662953. [PMID: 34026693 PMCID: PMC8138581 DOI: 10.3389/fped.2021.662953] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Kawasaki disease (KD), an acute febrile childhood illness and systemic vasculitis of unknown etiology, is the leading cause of acquired heart disease among children. Experimental data from murine models of KD vasculitis and transcriptomics data generated from whole blood of KD patients indicate the involvement of the NLRP3 inflammasome and interleukin-1 (IL-1) signaling in KD pathogenesis. MicroRNA-223 (miR-223) is a negative regulator of NLRP3 activity and IL-1β production, and its expression has been reported to be upregulated during acute human KD; however, the specific role of miR-223 during KD vasculitis remains unknown. Here, using the Lactobacillus casei cell wall extract (LCWE) murine model of KD vasculitis, we demonstrate increased miR-223 expression in LCWE-induced cardiovascular lesions. Compared with control WT mice, LCWE-injected miR-223-deficient mice (miR223 -/y ) developed more severe coronary arteritis and aortitis, as well as more pronounced abdominal aorta aneurysms and dilations. The enhanced cardiovascular lesions and KD vasculitis observed in LCWE-injected miR223 -/y mice correlated with increased NLRP3 inflammasome activity and elevated IL-1β production, indicating that miR-223 limits cardiovascular lesion development by downmodulating NLRP3 inflammasome activity. Collectively, our data reveal a previously unappreciated role of miR-223 in regulating innate immune responses and in limiting KD vasculitis and its cardiovascular lesions by constraining the NLRP3 inflammasome and the IL-1β pathway. These data also suggest that miR-223 expression may be used as a marker for KD vasculitis pathogenesis and provide a novel therapeutic target.
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Affiliation(s)
- Daisuke Maruyama
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Begüm Kocatürk
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Youngho Lee
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Masanori Abe
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Malcolm Lane
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Debbie Moreira
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Shuang Chen
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Department of Biomedical Sciences, Infectious and Immunological Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Michael C Fishbein
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rebecca A Porritt
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Department of Biomedical Sciences, Infectious and Immunological Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Magali Noval Rivas
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Department of Biomedical Sciences, Infectious and Immunological Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Moshe Arditi
- Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Department of Biomedical Sciences, Infectious and Immunological Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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10
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Koné-Paut I, Tellier S, Belot A, Brochard K, Guitton C, Marie I, Meinzer U, Cherqaoui B, Galeotti C, Boukhedouni N, Agostini H, Arditi M, Lambert V, Piedvache C. Phase II Open Label Study of Anakinra in Intravenous Immunoglobulin-Resistant Kawasaki Disease. Arthritis Rheumatol 2020; 73:151-161. [PMID: 32779863 DOI: 10.1002/art.41481] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Anakinra has been shown to be successful in preventing and treating cardiovascular lesions both in experimental murine models of Kawasaki disease (KD) and in several studies on intravenous immunoglobulin (IVIG)- and steroid-resistant patients with KD. This study was undertaken to determine the safety of blocking interleukin-1 in patients with IVIG-resistant KD. METHODS Sixteen patients were included in the present study. Patients with KD who were not responsive to 1 or more courses of 2 mg/kg of IVIG received anakinra by subcutaneous daily injections. Starting doses were 2 mg/kg of IVIG (4 mg/kg in patients who were age <8 months and who weighed ≥5 kilograms), and the dose was increased up to 6 mg/kg every 24 hours if the patient's body temperature remained >38°C, indicative of a fever. Treatment duration was 14 days. The last visit was on day 45. Primary outcome was abatement of fever. Secondary measures included disease activity, coronary artery Z score, and C-reactive protein (CRP) levels. RESULTS Seventy-five percent of patients in the intention-to-treat group and 87.5% in the per-protocol group became afebrile within 48 hours of the last escalation dose of anakinra. Reduction of disease activity by 50% was indicated on 93.3% (95% confidence interval [95% CI] 68.1-99.8%) of physician evaluations and on 100% (95% CI 73.5-100%) of parent evaluations. CRP values normalized by day 30. At the initial screening, 12 of 16 patients had a maximum coronary artery Z score of >2, and 10 of 16 patients had a maximum Z score of >2.5. At day 45, 5 of 10 patients (50% [95% CI 18.7-81.3%]) and 6 of 12 patients (50% [95% CI 21.1-78.9%]) had achieved coronary artery Z scores of <2.5 and <2, respectively. Five serious adverse events were observed in 3 patients, but no serious infections or deaths occurred. CONCLUSION Anakinra was well tolerated in the study patients and may have some efficacy in reducing fever, markers of systemic inflammation, and coronary artery dilatation in individuals with IVIG-refractory KD.
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Affiliation(s)
- Isabelle Koné-Paut
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Alexandre Belot
- University of Lyon, International Center for Research in Infectious Diseases, INSERM U1111, ENS, Lyon, France
| | | | - Corinne Guitton
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | - Isabelle Marie
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Bilade Cherqaoui
- CeRéMAIA, Bicêtre Hospital, AP-HP, University of Paris Sud Saclay, INSERM U1173, Paris, France
| | - Caroline Galeotti
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Helene Agostini
- AP-HP, University of Paris Saclay, Bicêtre Hospital, Paris, France
| | - Moshe Arditi
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Virginie Lambert
- Institut Mutualiste Montsouris and Bicêtre Hospital, AP-HP, University of Paris Sud Saclay, Paris, France
| | - Céline Piedvache
- AP-HP, University of Paris Saclay, Bicêtre Hospital, Paris, France
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11
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Maniscalco V, Abu-Rumeileh S, Mastrolia MV, Marrani E, Maccora I, Pagnini I, Simonini G. The off-label use of anakinra in pediatric systemic autoinflammatory diseases. Ther Adv Musculoskelet Dis 2020; 12:1759720X20959575. [PMID: 33149772 PMCID: PMC7580132 DOI: 10.1177/1759720x20959575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
Interleukin 1 (IL-1), a central mediator of innate immunity, is considered a master cytokine of local and systemic inflammation. IL-1 has emerged as pivotal in the pathogenesis of autoinflammatory diseases (AIDs), and blockade of its pathway has become a crucial target for therapy. Anakinra (ANA), a recombinant IL-1β receptor antagonist, was the first anti-IL-1 agent employed in clinical practice. ANA is currently approved for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis, adult-onset Still’s disease, and cryopyrin-associated autoinflammatory syndrome. It has also been successfully used for off-label treatment of various monogenic, polygenic, or undefined etiology systemic AIDs. This review describes currently available evidence for the off-label use of ANA in pediatric rheumatologic diseases. Specifically, the use of ANA in Kawasaki disease, idiopathic recurrent pericarditis, Behçet disease, monogenic AIDs, undifferentiated AIDs, chronic non-bacterial osteomyelitis, macrophage activation syndrome, and febrile infection-related epilepsy, in terms of its safety and efficacy. In selected pediatric rheumatic disorders, the off-label administration of ANA appears to be effective and safe. In order to control severe and/or relapsing disease, ANA should be considered as a valuable treatment option in children suffering from rare inflammatory diseases. However, currently available data consist of retrospective studies and short case series; thus, randomized controlled trials and larger series with long-term follow up are mandatory to better assess the efficacy and cost effectiveness of ANA in these challenging patients.
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Affiliation(s)
- Valerio Maniscalco
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini, 24, Firenze, Toscana 50139, Italy
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12
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Anakinra And Etanercept Combination Treatment in a Child With Severe, Nonresponsive Kawasaki Disease. Pediatr Infect Dis J 2020; 39:e310-e313. [PMID: 32618930 DOI: 10.1097/inf.0000000000002810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Kawasaki disease (KD) patients' resistance to treatment with intravenous immunoglobulins (IVIG) places them at high risk for an unfavorable progression of the disease. In these patients, there has been little evidence that alternative treatments are effective. Nevertheless, biologicals such as an interleukin-1-receptor blocker and tumor-necrosis-factor-α inhibitors increasingly have been used. If the patient does not respond to one of these therapeutics, a combination of 2 biologicals might be an alternative, but this is not yet generally accepted due to the potentially increased risk of infection. Here we report on a 3-month-old boy suffering from severe refractory KD. KD diagnosis was delayed due to the misinterpretation of a urinary tract infection and to the short and nonsimultaneous presence of classical KD symptoms. After complete KD later was able to be diagnosed, treatment with intravenous immunoglobulins was administered. However, the disease proved resistant to 2 courses of IVIG, as well as to corticosteroids. The patient developed giant coronary artery aneurysms early during the course of disease. Anakinra was initiated, but even with stepwise higher anakinra dosages, he remained febrile and coronary artery dimensions increased. Therefore, etanercept was added as a second biological. Only under combination treatment with anakinra and etanercept were his inflammation and fever able to be completely resolved. Coronary artery dimensions improved over time.
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13
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Abstract
Treatment of Kawasaki disease (KD) with intravenous immunoglobulin (IVIG) administered within the initial 10 days of fever onset decreases the risk of coronary artery aneurysms (CAAs) from ∼ 25% to less than 5%. However, patients with IVIG resistance, young infants, men, highly inflamed patients, and/or those with coronary changes at diagnosis remain at high risk for CAA. High-risk patients may benefit from acute, adjunctive antiinflammatory treatment in addition to IVIG. Optimal therapy remains unknown. This article reviews the acute pharmacologic management of patients with KD, focusing on adjunctive primary therapy options and treatment of patients with IVIG resistance.
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Affiliation(s)
- Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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14
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Yap JKY, Moriyama M, Iwasaki A. Inflammasomes and Pyroptosis as Therapeutic Targets for COVID-19. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2020; 205:307-312. [PMID: 32493814 PMCID: PMC7343621 DOI: 10.4049/jimmunol.2000513] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
The inflammatory response to severe acute respiratory syndrome-related coronavirus 2 infection has a direct impact on the clinical outcomes of coronavirus disease 2019 patients. Of the many innate immune pathways that are engaged by severe acute respiratory syndrome-related coronavirus 2, we highlight the importance of the inflammasome pathway. We discuss available pharmaceutical agents that target a critical component of inflammasome activation, signaling leading to cellular pyroptosis, and the downstream cytokines as a promising target for the treatment of severe coronavirus disease 2019-associated diseases.
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Affiliation(s)
- Jeremy K Y Yap
- School of Postgraduate Studies, International Medical University, 57000 Kuala Lumpur, Malaysia
| | - Miyu Moriyama
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520;
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, CT 06512; and
- Howard Hughes Medical Institute, Chevy Chase, MD 20815
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15
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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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16
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Complete Regression of Giant Aneurysms in an Infant with Delayed Diagnosis and Refractory Kawasaki Disease via Combination Anticytokine Therapy: Case Report and Review of Similar Cases. Case Rep Rheumatol 2020; 2020:6249013. [PMID: 32280552 PMCID: PMC7142349 DOI: 10.1155/2020/6249013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Kawasaki disease (KD) is an inflammatory vasculitis and is the most common cause of acquired childhood heart disease in developed countries. Current treatment with intravenous immunoglobulin (IVIG) is often ineffective in patients with delayed or refractory disease. We present a case of combination anticytokine therapy in an infant with delayed and refractory KD. Case Presentation. A 3-month-old infant presented with refractory KD with giant aneurysms after a delayed diagnosis of one month. Use of combination anticytokine therapy led to resolution of giant aneurysms over approximately 6 months. Conclusions Our case is unique in effective use of anticytokine therapy in very delayed disease with giant aneurysms. Additionally, we review other cases for a broader perspective. Prospective study of anticytokine therapy for patients with giant aneurysms may be warranted.
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17
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Porritt RA, Markman JL, Maruyama D, Kocaturk B, Chen S, Lehman TJA, Lee Y, Fishbein MC, Rivas MN, Arditi M. Interleukin-1 Beta-Mediated Sex Differences in Kawasaki Disease Vasculitis Development and Response to Treatment. Arterioscler Thromb Vasc Biol 2020; 40:802-818. [PMID: 31996019 PMCID: PMC7047651 DOI: 10.1161/atvbaha.119.313863] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Kawasaki disease (KD) is the leading cause of acute vasculitis and acquired heart disease in children in developed countries. Notably, KD is more prevalent in males than females. We previously established a key role for IL (interleukin)-1 signaling in KD pathogenesis, but whether this pathway underlies the sex-based difference in susceptibility is unknown. Approach and Results: The role of IL-1 signaling was investigated in the Lactobacillus casei cell wall extract-induced experimental mouse model of KD vasculitis. Five-week-old male and female mice were injected intraperitoneally with PBS, Lactobacillus caseicell wall extract, or a combination of Lactobacillus caseicell wall extract and the IL-1 receptor antagonist Anakinra. Aortitis, coronary arteritis inflammation score and abdominal aorta dilatation, and aneurysm development were assessed. mRNA-seq (messenger RNA sequencing) analysis was performed on abdominal aorta tissue. Publicly available human transcriptomics data from patients with KD was analyzed to identify sex differences and disease-associated genes. Male mice displayed enhanced aortitis and coronary arteritis as well as increased incidence and severity of abdominal aorta dilatation and aneurysm, recapitulating the increased incidence in males that is observed in human KD. Gene expression data from patients with KD and abdominal aorta tissue of Lactobacillus caseicell wall extract-injected mice showed enhanced Il1b expression and IL-1 signaling genes in males. Although the more severe IL-1β-mediated disease phenotype observed in male mice was ameliorated by Anakinra treatment, the milder disease phenotype in female mice failed to respond. CONCLUSIONS IL-1β may play a central role in mediating sex-based differences in KD, with important implications for the use of anti-IL-1β therapies to treat male and female patients with KD.
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Affiliation(s)
- Rebecca A. Porritt
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Janet L. Markman
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Daisuke Maruyama
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Begum Kocaturk
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Shuang Chen
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
- Department of Biomedical Sciences, Infectious and Immunologic Disease Research Center, Los Angeles, California 90048, USA
- Department of Biomedical Science, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
| | - Thomas J. A. Lehman
- Department of Pediatrics, Division of Rheumatology, Weill Cornell Medical School, New York, NY, 10065, USA
| | - Youngho Lee
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Michael C Fishbein
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
| | - Magali Noval Rivas
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
- Department of Biomedical Sciences, Infectious and Immunologic Disease Research Center, Los Angeles, California 90048, USA
- Department of Biomedical Science, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
| | - Moshe Arditi
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
- Department of Biomedical Sciences, Infectious and Immunologic Disease Research Center, Los Angeles, California 90048, USA
- Department of Biomedical Science, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
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18
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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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19
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Ferrara G, Giani T, Caparello MC, Farella C, Gamalero L, Cimaz R. Anakinra for Treatment-Resistant Kawasaki Disease: Evidence from a Literature Review. Paediatr Drugs 2020; 22:645-652. [PMID: 32885390 PMCID: PMC7471561 DOI: 10.1007/s40272-020-00421-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of childhood and the main cause of acquired heart disease in developed countries. Intravenous immunoglobulin (IVIG) in association with aspirin represents the main treatment for KD. However, 10-20% of patients fail to respond to standard treatment and have an increased risk of cardiac complications. There is currently no accepted protocol for treatment of resistant cases. Several authors highlighted the role of interleukin-1 (IL-1) as a mediator of inflammation in KD and suggested the possibility of using IL-1 or its receptor as a target of therapy. The use of IL-1 inhibitors in patients with KD has been reported in the scientific literature, but data are largely limited to individual case reports and small case series. We summarized the scientific literature related to the use of anakinra, analyzing preclinical and clinical data. Thirty-eight patients have been described so far, most of them with KD-related complications. Twenty-two were described in case reports and case series, while 16 were patients from the completed KAWAKINRA phase IIa study. Almost all patients received clinical benefit, and no relevant side effects were noted. Based on this evidence, in our opinion, anakinra may be considered as an option after the failure of the first IVIG infusion, especially in patients with coronary involvement.
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Affiliation(s)
| | - Teresa Giani
- AOU Meyer, Florence, Italy. .,Department of Medical Biotechnology, University of Siena, Siena, Italy.
| | | | | | | | - Rolando Cimaz
- ASST G-Pini, Milan, Italy ,Department of Clinical Sciences and Community Health and RECAP-RD, University of Milan, Milan, Italy
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20
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Duignan S, Doyle SL, McMahon CJ. Refractory Kawasaki disease: diagnostic and management challenges. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2019; 10:131-139. [PMID: 31802968 PMCID: PMC6826175 DOI: 10.2147/phmt.s165935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/23/2019] [Indexed: 01/27/2023]
Abstract
Kawasaki disease (KD), an acute, self-limiting, medium-sized arterial vasculitis, is now the most common cause of acquired heart disease in childhood in the developed world. In this review, we discuss the diagnosis of KD, predicting resistance to traditional therapy and treatment options in refractory or high-risk disease. We also highlight ongoing clinical trials and other potential avenues of research which may prove beneficial in managing children, especially those with resistant KD.
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Affiliation(s)
- Sophie Duignan
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Dublin 12, Ireland.,Department of Immunology, National Children's Research Centre, Dublin, Ireland
| | - Sarah L Doyle
- Department of Immunology, National Children's Research Centre, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Dublin 12, Ireland.,Department of Immunology, National Children's Research Centre, Dublin, Ireland
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21
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Lind-Holst M, Hartling UB, Christensen AE. High-dose anakinra as treatment for macrophage activation syndrome caused by refractory Kawasaki disease in an infant. BMJ Case Rep 2019; 12:e229708. [PMID: 31383678 PMCID: PMC6685371 DOI: 10.1136/bcr-2019-229708] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 02/04/2023] Open
Abstract
We report a 12-week-old boy presenting with incomplete refractory Kawasaki disease (KD) complicated with macrophage activation syndrome (MAS). The infant presented with cerebral irritability, pain, tachypnoea and vomiting for 10 days. He did not fulfil any of the classic diagnostic criteria for KD. Pericardial effusion on echocardiography in addition to severe dilatation of the coronary arteries in combination with leucocytosis and raised acute phase reactants led to the diagnosis of incomplete KD. Treatment with intravenous immunoglobulin and aspirin was initiated but without any response. The condition was subsequently refractory to additional treatment with infliximab and high-dose methylprednisolone. His condition worsened, fulfilling the criteria for MAS. High-dose anakinra was initiated, and remission of the inflammation was achieved.
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Affiliation(s)
- Marie Lind-Holst
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Ulla Birgitte Hartling
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
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22
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Zhu L, Lao L, Huang Y, Lin X, Liu J. A child with Kawasaki disease successfully treated with Chinese herbal medicine: A case report with 12-month follow up. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Kawasaki disease triggered by parvovirus infection: an atypical case report of two siblings. J Med Case Rep 2019; 13:104. [PMID: 31014402 PMCID: PMC6480815 DOI: 10.1186/s13256-019-2028-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/24/2019] [Indexed: 12/11/2022] Open
Abstract
Background There are reports of the familial occurrence of Kawasaki disease but only a few reports described Kawasaki disease in siblings. However, the familial cases were not simultaneous. In these patients the idea of infective agents as trigger must be considered. Case presentation We describe two siblings with atypical presentations of Kawasaki disease; the sister was first diagnosed as having parvovirus infection with anemia and the brother was diagnosed as having myocarditis. The first patient was a 9-month-old Caucasian girl with fever, conjunctivitis, rash, and pharyngitis, and later she had cervical adenopathy, diarrhea and vomiting, leukocytosis, and anemia, which were explained by positive immunoglobulin M against parvovirus. However, coronary artery lesions with aneurysms were documented at day 26 after fever onset. An infusion of intravenous immunoglobulin and high doses of steroids were not efficacious to resolve the coronary lesions. She was treated with anakinra, despite a laboratory test not showing inflammation, with prompt and progressive improvement of coronary lesions. Her 7-year-old Caucasian brother presented vomiting and fever at the same time as she was unwell, which spontaneously resolved after 4 days. Four days later, he again presented with fever with abdominal pain, associated with tachypnea, stasis at the pulmonary bases, tachycardia, gallop rhythm, hypotension, secondary anuria, and hepatomegaly. An echocardiogram revealed a severe hypokinesia, with a severe reduction of the ejection fraction (20%). He had an increase of immunoglobulin M anti-parvovirus, tested for the index case of his sister, confirming the suspicion of viral myocarditis. He received dopamine, dobutamine, furosemide plus steroids, with a progressive increase of the ejection fraction to 50%. However, evaluating his sister’s history, the brother showed a myocardial dysfunction secondary to Kawasaki shock syndrome. Conclusions We report on familial Kawasaki disease in two siblings which had the same infectious trigger (a documented parvovirus infection). The brother was diagnosed as having post-viral myocarditis. However, in view of the two different and simultaneous evolutions, the girl showed Kawasaki disease with late coronary artery lesions and aneurysms, whereas the brother showed Kawasaki shock syndrome with myocardial dysfunction. We stress the effectiveness of anakinra in non-responder Kawasaki disease and the efficacy on coronary aneurysms.
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24
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Unveiling the Efficacy, Safety, and Tolerability of Anti-Interleukin-1 Treatment in Monogenic and Multifactorial Autoinflammatory Diseases. Int J Mol Sci 2019; 20:ijms20081898. [PMID: 30999610 PMCID: PMC6514653 DOI: 10.3390/ijms20081898] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023] Open
Abstract
Autoinflammatory diseases (AIDs) are heterogeneous disorders characterized by dysregulation in the inflammasome, a large intracellular multiprotein platform, leading to overproduction of interleukin-1(IL-1)β that plays a predominant pathogenic role in such diseases. Appropriate treatment is crucial, also considering that AIDs may persist into adulthood with negative consequences on patients' quality of life. IL-1β blockade results in a sustained reduction of disease severity in most AIDs. A growing experience with the human IL-1 receptor antagonist, Anakinra (ANA), and the monoclonal anti IL-1β antibody, Canakinumab (CANA), has also been engendered, highlighting their efficacy upon protean clinical manifestations of AIDs. Safety and tolerability have been confirmed by several clinical trials and observational studies on both large and small cohorts of AID patients. The same treatment has been proposed in refractory Kawasaki disease, an acute inflammatory vasculitis occurring in children before 5 years, which has been postulated to be autoinflammatory for its phenotypical and immunological similarity with systemic juvenile idiopathic arthritis. Nevertheless, minor concerns about IL-1 antagonists have been raised regarding their employment in children, and the development of novel pharmacological formulations is aimed at minimizing side effects that may affect adherence to treatment. The present review summarizes current findings on the efficacy, safety, and tolerability of ANA and CANA for treatment of AIDs and Kawasaki vasculitis with a specific focus on the pediatric setting.
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Association of miR-146a Gene Polymorphism at loci rs2910164 G/C, rs57095329 A/G, and rs6864584 T/C with Susceptibility to Kawasaki Disease in Chinese Children. Pediatr Cardiol 2019; 40:504-512. [PMID: 30291383 DOI: 10.1007/s00246-018-2002-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the genetic association of miR-146a gene polymorphisms at loci rs2910164 G/C, rs57095329 A/G, and rs6864584 T/C in patients with Kawasaki disease (KD) and coronary artery lesions (CAL). METHODS There were 120 patients with KD and 126 healthy subjects in this study. The genotype of loci rs2910164 G/C, rs57095329 A/G, and rs6864584 T/C of miR-146a gene were detected by polymerase chain reaction-sequence-based typing. RESULTS For miR-146a gene polymorphisms at loci rs2910164 G/C, rs57095329 A/G, and rs6864584 T/C, there were no significant difference of genotype frequencies and allele frequencies between KD group and healthy control group, or between the IVIG-resistant group and IVIG-sensitive group (P > 0.05). In KD with coronary artery lesions (KD-CAL) group, the genotype frequencies of GG were higher than that in KD without coronary artery lesion (KD-WO) group at locus rs2910164 G/C polymorphisms of miR-146a gene (χ2 = 6.660, P = 0.036), patients with KD carried genotype of GG were at 3.636 times higher risk of getting coronary artery lesions than those of non-carriers (χ2 = 6.455, P = 0.018, OR = 3.636, 95%CI = 1.280-10.262). While there was no significant difference of allele frequency of G and C between KD-CAL group and KD-WO group (P > 0.05). In KD-CAL group, the allele frequency of A was higher than that in KD-WO group at locus rs57095329 A/G polymorphisms of miR-146a gene (χ2 = 4.745, P = 0.035), carriers with allele A were at 2.422 times higher risk of getting coronary artery lesions than those of non-carriers (χ2 = 4.745, P = 0.035, OR = 2.422, 95%CI = 1.073-5.465), while there was no significant difference of genotype frequency of AA, AG, and GG types between KD-CAL group and KD-WO group (P > 0.05). There was no significant difference of genotype frequencies of TT, TC, and CC types and allele frequencies of T and C types between KD-CAL group and KD-WO group at locus rs6864584 T/C polymorphisms of miR-146a gene (P > 0.05). CONCLUSIONS The significant association has been found between the genotype and allele frequency of the miR-146a gene loci rs2910164 G/C and rs57095329 A/G, the genotype GG of rs2910164 G/C, and allele A of rs57095329 A/G were risk factors for getting coronary artery lesions.
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Pilania RK, Jindal AK, Guleria S, Singh S. An Update on Treatment of Kawasaki Disease. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00115-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Marrani E, Burns JC, Cimaz R. How Should We Classify Kawasaki Disease? Front Immunol 2018; 9:2974. [PMID: 30619331 PMCID: PMC6302019 DOI: 10.3389/fimmu.2018.02974] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
The exact classification of Kawasaki disease (KD) has been debated. Infectious disease specialists have claimed it as an infection with a classic immune responses to an as yet unidentified pathogen that localizes to the coronary arteries. Others have favored an autoreactive hypothesis that KD is triggered by an antigen that shares homology with structures in the vascular wall, and molecular mimicry resulting in an immune response directed to that tissue. Rheumatologists have classified it as a systemic vasculitis, while some immunologists have stressed the robust nature of the innate immune response that causes both systemic inflammation as well as damage to the coronary arterial wall and questioned whether KD falls within the spectrum of autoinflammatory diseases. This review will describe the evidences available up to now regarding these hypotheses.
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Affiliation(s)
- Edoardo Marrani
- Rheumatology Unit, Department of Neurosciences, Psychology, Drug Research and Child Health, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Jane C Burns
- Department of Pediatrics, Kawasaki Disease Research Center, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
| | - Rolando Cimaz
- Rheumatology Unit, Department of Neurosciences, Psychology, Drug Research and Child Health, Meyer Children's Hospital, University of Florence, Florence, Italy
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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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Kone-Paut I, Cimaz R, Herberg J, Bates O, Carbasse A, Saulnier JP, Maggio MC, Anton J, Piram M. The use of interleukin 1 receptor antagonist (anakinra) in Kawasaki disease: A retrospective cases series. Autoimmun Rev 2018; 17:768-774. [DOI: 10.1016/j.autrev.2018.01.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/25/2018] [Indexed: 12/20/2022]
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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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Abstract
BACKGROUND The pathogenesis of Kawasaki disease are still not well understood. It was designed to investigate the relationship between adipokines including chemerin, omentin-1, adiponectin and acute Kawasaki disease. METHODS Enzyme-linked immunosorbent (ELISA) was used to detect serum levels of chemerin, omentin-1, adiponectin, and inflammatory cytokines IL-1β and TNF-α in 80 cases of patients diagnosed with Kawasaki disease (KD). In addition, 20 cases of children with fever and 20 cases of healthy children were selected as febrile and normal controls. RESULTS (1) Serum levels of chemerin in KD group (87.736 ± 56.310) are higher than that of both the healthy (41.746 ± 10.824) and the febrile controls (59.683 ± 18.282) (P < 0.01). (2) Circulating omentin-1 levels in Kawasaki disease group (389.773 ± 238.611) are significantly lower than that of febrile control (542.075 ± 177.995) (P < 0.01), also serum adiponectin levels in Kawasaki disease group (16.400 ± 12.243) reduced obviously compared with the febrile control group (35.074 ± 12.486). (3)Serum cytokine levels of IL-1β in Kawasaki disease group (13.656 ± 31.151) are higher than those of normal controls (2.415 ± 6.313) (P < 0.05). (4) Correlation analysis indicates that serum levels of chemerin are positively correlated with omentin-1 (r = 0.224, 95% CI 0.06-0.529, P < 0.05). Further, serum omentin-1 levels and total cholesterol (TC) are positively correlated (r = 0.358, 95% CI 0.169-0.518, P < 0.01). CONCLUSIONS Circulating chemerin increased significantly in the acute stage of Kawasaki disease, while omentin-1 and adiponectin levels are decreased. These adipokines are closely associated with the early inflammation and lipid metabolism disorders of acute Kawasaki disease.
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Abstract
Kawasaki disease is an acute self-limited vasculitis of unknown aetiology. The prognosis depends mainly on coronary damage. There is no consensus regarding optimal adjunctive therapeutics for refractory forms to treatment by intravenous immunoglobulins and corticosteroids. We report the case of an 18-month-old infant with refractory Kawasaki disease complicated by diffuse aneurysms of coronary arteries and successfully treated by anakinra with partial regression of coronary aneurysms.
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Pilania RK, Bhattarai D, Singh S. Controversies in diagnosis and management of Kawasaki disease. World J Clin Pediatr 2018; 7:27-35. [PMID: 29456929 PMCID: PMC5803562 DOI: 10.5409/wjcp.v7.i1.27] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 02/06/2023] Open
Abstract
Kawasaki disease (KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.
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Affiliation(s)
- Rakesh Kumar Pilania
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Dharmagat Bhattarai
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Abstract
"Resistant" Kawasaki disease is defined by the American Heart Association as failure to respond within 36 h following the first dose of intravenous immunoglobulin. The optimal management of resistant Kawasaki disease remains uncertain, the outcomes are potentially serious, and the cost of some treatments is considerable. We review the current evidence to guide treatment of resistant Kawasaki disease. Given the relative rarity, there are few trial data, and studies tend to be small and methodologically heterogeneous, making interpretation difficult and limiting generalisability. The literature on resistant Kawasaki disease should be interpreted with reference to current expert consensus guidelines.
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