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Lech M, Guess J, Duffner J, Oyamada J, Shimizu C, Hoshino S, Farutin V, Bulik DA, Gutierrez B, Sarvaiya H, Kapoor B, Koppes L, Saldova R, Stockmann H, Albrecht S, McManus C, Rudd PM, Kaundinya GV, Manning AM, Bosques CJ, Kahn AM, Daniels LB, Gordon JB, Tremoulet AH, Capila I, Gunay NS, Ling LE, Burns JC. Circulating Markers of Inflammation Persist in Children and Adults With Giant Aneurysms After Kawasaki Disease. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 12:e002433. [DOI: 10.1161/circgen.118.002433] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
The sequelae of Kawasaki disease (KD) vary widely with the greatest risk for future cardiovascular events among those who develop giant coronary artery aneurysms (CAA). We sought to define the molecular signature associated with different outcomes in pediatric and adult KD patients.
Methods:
Molecular profiling was conducted using mass spectrometry–based shotgun proteomics, transcriptomics, and glycomics methods on 8 pediatric KD patients at the acute, subacute, and convalescent time points. Shotgun proteomics was performed on 9 KD adults with giant CAA and matched healthy controls. Plasma calprotectin was measured by ELISA in 28 pediatric KD patients 1 year post-KD, 70 adult KD patients, and 86 healthy adult volunteers.
Results:
A characteristic molecular profile was seen in pediatric patients during the acute disease, which resolved at the subacute and convalescent periods in patients with no coronary artery sequelae but persisted in 2 patients who developed giant CAA. We, therefore, investigated persistence of inflammation in KD adults with giant CAA by shotgun proteomics that revealed a signature of active inflammation, immune regulation, and cell trafficking. Correlating results obtained using shotgun proteomics in the pediatric and adult KD cohorts identified elevated calprotectin levels in the plasma of patients with CAA. Investigation of expanded pediatric and adult KD cohorts revealed elevated levels of calprotectin in pediatric patients with giant CAA 1 year post-KD and in adult KD patients who developed giant CAA in childhood.
Conclusions:
Complex patterns of biomarkers of inflammation and cell trafficking can persist long after the acute phase of KD in patients with giant CAA. Elevated levels of plasma calprotectin months to decades after acute KD and infiltration of cells expressing S100A8 and A9 in vascular tissues suggest ongoing, subclinical inflammation. Calprotectin may serve as a biomarker to inform the management of KD patients following the acute illness.
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Affiliation(s)
- Miroslaw Lech
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Jamey Guess
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Jay Duffner
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Jun Oyamada
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
| | - Chisato Shimizu
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
| | - Shinsuke Hoshino
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
| | - Victor Farutin
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Dorota A. Bulik
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Bryan Gutierrez
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Hetal Sarvaiya
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Bulbul Kapoor
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Laura Koppes
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Radka Saldova
- National Institute for Bioprocessing Research and Training GlycoScience Group, Dublin, Ireland (R.S., H.S., S.A., C.M., P.M.R.)
| | - Henning Stockmann
- National Institute for Bioprocessing Research and Training GlycoScience Group, Dublin, Ireland (R.S., H.S., S.A., C.M., P.M.R.)
| | - Simone Albrecht
- National Institute for Bioprocessing Research and Training GlycoScience Group, Dublin, Ireland (R.S., H.S., S.A., C.M., P.M.R.)
| | - Ciara McManus
- National Institute for Bioprocessing Research and Training GlycoScience Group, Dublin, Ireland (R.S., H.S., S.A., C.M., P.M.R.)
| | - Pauline M. Rudd
- National Institute for Bioprocessing Research and Training GlycoScience Group, Dublin, Ireland (R.S., H.S., S.A., C.M., P.M.R.)
| | - Ganesh V. Kaundinya
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Anthony M. Manning
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Carlos J. Bosques
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Andrew M. Kahn
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
| | - Lori B. Daniels
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
| | | | - Adriana H. Tremoulet
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
- Rady Children’s Hospital–San Diego (A.H.T., J.C.B.)
| | - Ishan Capila
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Nur Sibel Gunay
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Leona E. Ling
- Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.)
| | - Jane C. Burns
- University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.)
- Rady Children’s Hospital–San Diego (A.H.T., J.C.B.)
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Huseby Kelcher AM, Atanga PA, Gamez JD, Cumba Garcia LM, Teclaw SJ, Pavelko KD, Macura SI, Johnson AJ. Brain atrophy in picornavirus-infected FVB mice is dependent on the H-2D b class I molecule. FASEB J 2017; 31:2267-2275. [PMID: 28188174 DOI: 10.1096/fj.201601055r] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/23/2017] [Indexed: 01/09/2023]
Abstract
Brain atrophy is a common feature of numerous neurologic diseases in which the role of neuroinflammation remains ill-defined. In this study, we evaluated the contribution of major histocompatibility complex class I molecules to brain atrophy in Theiler's murine encephalomyelitis virus (TMEV)-infected transgenic FVB mice that express the Db class I molecule. FVB/Db and wild-type FVB mice were evaluated for changes in neuroinflammation, virus clearance, neuropathology, and development of brain atrophy via T2-weighted MRI and subsequent 3-dimensional volumetric analysis. Significant brain atrophy and hippocampal neuronal loss were observed in TMEV-infected FVB/Db mice, but not in wild-type FVB mice. Brain atrophy was observed at 1 mo postinfection and persisted through the 4-mo observation period. Of importance, virus-infected FVB/Db mice elicited a strong CD8 T-cell response toward the immunodominant Db-restricted TMEV-derived peptide, VP2121-130, and cleared TMEV from the CNS. In addition, immunofluorescence revealed CD8 T cells near virus-infected neurons; therefore, we hypothesize that class I restricted CD8 T-cell responses promote development of brain atrophy. This model provides an opportunity to analyze the contribution of immune cells to brain atrophy in a system where persistent virus infection and demyelination are not factors in long-term neuropathology.-Huseby Kelcher, A. M., Atanga, P. A., Gamez, J. D., Cumba Garcia, L. M., Teclaw, S. J., Pavelko, K. D., Macura, S. I., Johnson. A. J. Brain atrophy in picornavirus-infected FVB mice is dependent on the H-2Db class I molecule.
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Affiliation(s)
- April M Huseby Kelcher
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pascal A Atanga
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey D Gamez
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Luz M Cumba Garcia
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin D Pavelko
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Slobodan I Macura
- Nuclear Magnetic Resonance Core Facility, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Johnson
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA; .,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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5
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Lovelace MD, Varney B, Sundaram G, Franco NF, Ng ML, Pai S, Lim CK, Guillemin GJ, Brew BJ. Current Evidence for a Role of the Kynurenine Pathway of Tryptophan Metabolism in Multiple Sclerosis. Front Immunol 2016; 7:246. [PMID: 27540379 PMCID: PMC4972824 DOI: 10.3389/fimmu.2016.00246] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/10/2016] [Indexed: 12/13/2022] Open
Abstract
The kynurenine pathway (KP) is the major metabolic pathway of the essential amino acid tryptophan (TRP). Stimulation by inflammatory molecules, such as interferon-γ (IFN-γ), is the trigger for induction of the KP, driving a complex cascade of production of both neuroprotective and neurotoxic metabolites, and in turn, regulation of the immune response and responses of brain cells to the KP metabolites. Consequently, substantial evidence has accumulated over the past couple of decades that dysregulation of the KP and the production of neurotoxic metabolites are associated with many neuroinflammatory and neurodegenerative diseases, including Parkinson’s disease, AIDS-related dementia, motor neurone disease, schizophrenia, Huntington’s disease, and brain cancers. In the past decade, evidence of the link between the KP and multiple sclerosis (MS) has rapidly grown and has implicated the KP in MS pathogenesis. KP enzymes, indoleamine 2,3-dioxygenase (IDO-1) and tryptophan dioxygenase (highest expression in hepatic cells), are the principal enzymes triggering activation of the KP to produce kynurenine from TRP. This is in preference to other routes such as serotonin and melatonin production. In neurological disease, degradation of the blood–brain barrier, even if transient, allows the entry of blood monocytes into the brain parenchyma. Similar to microglia and macrophages, these cells are highly responsive to IFN-γ, which upregulates the expression of enzymes, including IDO-1, producing neurotoxic KP metabolites such as quinolinic acid. These metabolites circulate systemically or are released locally in the brain and can contribute to the excitotoxic death of oligodendrocytes and neurons in neurological disease principally by virtue of their agonist activity at N-methyl-d-aspartic acid receptors. The latest evidence is presented and discussed. The enzymes that control the checkpoints in the KP represent an attractive therapeutic target, and consequently several KP inhibitors are currently in clinical trials for other neurological diseases, and hence may make suitable candidates for MS patients. Underpinning these drug discovery endeavors, in recent years, several advances have been made in how KP metabolites are assayed in various biological fluids, and tremendous advancements have been made in how specimens are imaged to determine disease progression and involvement of various cell types and molecules in MS.
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Affiliation(s)
- Michael D Lovelace
- Applied Neurosciences Program, Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia; Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Bianca Varney
- Applied Neurosciences Program, Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research , Sydney, NSW , Australia
| | - Gayathri Sundaram
- Applied Neurosciences Program, Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research , Sydney, NSW , Australia
| | - Nunzio F Franco
- Applied Neurosciences Program, Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research , Sydney, NSW , Australia
| | - Mei Li Ng
- Faculty of Medicine, Sydney Medical School, University of Sydney , Sydney, NSW , Australia
| | - Saparna Pai
- Sydney Medical School, University of Sydney , Sydney, NSW , Australia
| | - Chai K Lim
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, NSW , Australia
| | - Gilles J Guillemin
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, NSW , Australia
| | - Bruce J Brew
- Applied Neurosciences Program, Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia; Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Neurology, St Vincent's Hospital, Sydney, NSW, Australia
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