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Huang C, Wang W, Huang H, Jiang J, Ding Y, Li X, Ma J, Hou M, Pu X, Qian G, Lv H. Kawasaki disease: ubiquitin-specific protease 5 promotes endothelial inflammation via TNFα-mediated signaling. Pediatr Res 2023; 93:1883-1890. [PMID: 36329225 DOI: 10.1038/s41390-022-02341-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to explore the functions of ubiquitin-specific protease 5 (USP5) in the endothelial inflammation of Kawasaki disease (KD). METHODS USP5 expression levels in HCAECs were examined after stimulation with TNFα or KD sera. The inflammatory cytokine expression level and nuclear factor κB (NF-κB) signaling activation proteins were also investigated in HCAECs by using USP5 overexpression/knockdown lentivirus as well as its small molecule inhibitor vialinin A. RESULTS USP5 expression level is upregulated in HCAECs after stimulation with KD sera. Similarly, the USP5 expression level is also increased in a time- and dose-dependent manner upon TNFα stimulation in HCAECs. Moreover, USP5 sustains proinflammatory cytokine production and NF-κB signaling activation, whereas USP5 knockdown causes the proinflammatory cytokine levels to decrease and suppress NF-κB signaling activation. Notably, the USP5 inhibitor vialinin A can suppress the expression of inflammatory genes induced by TNFα and IL-1β in HCAECs. CONCLUSIONS Our study identified USP5 as a positive regulator of TNFα production and its downstream signaling activation during the inflammatory responses in HCAECs, and demonstrated that its inhibitor vialinin A might serve as a candidate drug for KD therapy to prevent the excessive production of proinflammatory cytokines. IMPACT USP5 is upregulated in human coronary artery endothelial cells (HCAECs) whether incubated with acute KD sera or TNFα in vitro. USP5 promotes proinflammatory cytokine expression by sustaining NF-κB signaling activation in HCAECs. The USP5 inhibitor vialinin A can suppress the expression levels of proinflammatory cytokines in HCAEC, thus providing a novel mechanism and intervention strategy in KD therapy.
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Affiliation(s)
- Chengcheng Huang
- Institute of Pediatric Research, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
- Department of Pediatric, Yijishan Hospital, Wannan Medical College, 241001, Wuhu, Anhui, China
| | - Wang Wang
- School of Biology & Basic Medical Sciences, Suzhou Medical College of Soochow University, 215123, Suzhou, Jiangsu, China
- Department of Cardiology, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Hongbiao Huang
- Institute of Pediatric Research, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Jiaqi Jiang
- Institute of Pediatric Research, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Yueyue Ding
- Department of Cardiology, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Jin Ma
- Department of Cardiology, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Miao Hou
- Department of Cardiology, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Xiangqiang Pu
- Institute of Pediatric Research, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China
| | - Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China.
| | - Haitao Lv
- Institute of Pediatric Research, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China.
- Department of Cardiology, Children's Hospital of Soochow University, 215025, Suzhou, Jiangsu, China.
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Sun WJ, Sun YH. [Recent research on the nuclear factor-kappa B signaling pathway in cardiac injury in children with Kawasaki disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:250-252. [PMID: 36946158 PMCID: PMC10032074 DOI: 10.7499/j.issn.1008-8830.2209008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is a systemic acute vasculitis belonging to autoimmune disease. Up to now, the specific pathogenesis of this disease remains unclear, and it may involve various factors such as immune response, inflammatory response, and vascular endothelial injury caused by the activation of the nuclear factor-kappa B (NF-κB) signaling pathway. In particular, children with KD and cardiac injury tend to have a poor prognosis, and researchers hope to explore the specific pathogenesis of cardiac injury in KD to provide new options for clinical diagnosis and treatment and reduce the incidence rate of this disorder. This article reviews the recent research on the role of the NF-κB signaling pathway in cardiac injury in children with KD, so as to provide a basis for future studies.
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Affiliation(s)
- Wen-Juan Sun
- Department of Pediatrics, Gansu Provincial People's Hospital, Lanzhou 730030, China
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3
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Stock AT, Parsons S, D'Silva DB, Hansen JA, Sharma VJ, James F, Starkey G, D'Costa R, Gordon CL, Wicks IP. Mechanistic Target of Rapamycin Inhibition Prevents Coronary Artery Remodeling in a Murine Model of Kawasaki Disease. Arthritis Rheumatol 2023; 75:305-317. [PMID: 36057112 DOI: 10.1002/art.42340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/23/2022] [Accepted: 08/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Remodeling of the coronary arteries is a common feature in severe cases of Kawasaki disease (KD). This pathology is driven by the dysregulated proliferation of vascular fibroblasts, which can lead to coronary artery aneurysms, stenosis, and myocardial ischemia. We undertook this study to investigate whether inhibiting fibroblast proliferation might be an effective therapeutic strategy to prevent coronary artery remodeling in KD. METHOD We used a murine model of KD (induced by the injection of the Candida albicans water-soluble complex [CAWS]) and analyzed patient samples to evaluate potential antifibrotic therapies for KD. RESULTS We identified the mechanistic target of rapamycin (mTOR) pathway as a potential therapeutic target in KD. The mTOR inhibitor rapamycin potently inhibited cardiac fibroblast proliferation in vitro, and vascular fibroblasts up-regulated mTOR kinase signaling in vivo in the CAWS mouse model of KD. We evaluated the in vivo efficacy of mTOR inhibition and found that the therapeutic administration of rapamycin reduced vascular fibrosis and intimal hyperplasia of the coronary arteries in CAWS-injected mice. Furthermore, the analysis of cardiac tissue from KD fatalities revealed that vascular fibroblasts localizing with inflamed coronary arteries up-regulate mTOR signaling, confirming that the mTOR pathway is active in human KD. CONCLUSION Our findings demonstrate that mTOR signaling contributes to coronary artery remodeling in KD, and that targeting this pathway offers a potential therapeutic strategy to prevent or restrict this pathology in high-risk KD patients.
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Affiliation(s)
- Angus T Stock
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Sarah Parsons
- Department of Forensic Medicine, Monash University, and Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Damian B D'Silva
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jacinta A Hansen
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Varun J Sharma
- Liver & Intestinal Transplant Unit, Department of Surgery, and Department of Cardiac Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Fiona James
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Graham Starkey
- Liver & Intestinal Transplant Unit and Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Rohit D'Costa
- DonateLife Victoria, Carlton, Victoria, Australia, and Department of Intensive Care Medicine, Melbourne Health, Melbourne, Victoria, Australia
| | - Claire L Gordon
- Department of Infectious Diseases, Austin Health, Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, and North Eastern Public Health Unit, Austin Health, Melbourne, Victoria, Australia
| | - Ian P Wicks
- Walter and Eliza Hall Institute of Medical Research, Rheumatology Unit, The Royal Melbourne Hospital, and University of Melbourne, Department of Medical Biology, Victoria, Australia
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4
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Du Y, Lee PY. At the Heart of Treating Kawasaki Disease: The Search for New Approaches to Prevent Coronary Artery Aneurysms. Arthritis Rheumatol 2023; 75:149-152. [PMID: 36066560 PMCID: PMC9892198 DOI: 10.1002/art.42346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/01/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Yan Du
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pui Y. Lee
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Inositol-Triphosphate 3-Kinase C and DNA Methylation Involvement in NLRP3 Inflammasome Activation in Kawasaki Disease. Indian J Pediatr 2023; 90:22-28. [PMID: 35353363 DOI: 10.1007/s12098-022-04126-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate ITPKC and NLRP3 expression in children with Kawasaki disease (KD) and investigate the relationship between serum pro-inflammatory cytokines triggered by NLRP3 and inflammatory indices. Simultaneously, the methylation level in the ITPKC promoter was evaluated in children with KD. METHODS Children who satisfied the American Heart Association diagnostic criteria for KD were enrolled in the study from August 2018 to January 2019. The levels of ITPKC, NLRP3, IL-1β, and IL-18 were measured. The effect of DNA methylation on the activity of the ITPKC promoter was observed. Methylation-specific PCR was used to verify methylation modification of the ITPKC promoter region in children with KD. RESULTS ITPKC expression was downregulated in patients with KD, whereas NLRP3 was upregulated. Expression of the downstream cytokine, IL-18, was significantly upregulated in children with KD and correlated positively with inflammatory indices. Modifying DNA methylation significantly decreased the luciferase activity of the plasmid containing the ITPKC promoter region and thus, may inhibit ITPKC gene promoter activity. Furthermore, methylation modification was observed in the ITPKC promoter region of children with KD. CONCLUSION Modification of DNA methylation inhibits ITPKC promoter activity and is involved in NLRP3 inflammasome activation in children with KD.
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Chen KD, Huang YH, Wu WS, Chang LS, Chu CL, Kuo HC. Comparable bidirectional neutrophil immune dysregulation between Kawasaki disease and severe COVID-19. Front Immunol 2022; 13:995886. [PMID: 36159873 PMCID: PMC9499176 DOI: 10.3389/fimmu.2022.995886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Kawasaki disease (KD), a multisystem inflammatory syndrome that occurs in children, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) may share some overlapping mechanisms. The purpose of this study was to analyze the differences in single-cell RNA sequencing between KD and COVID-19. We performed single-cell RNA sequencing in KD patients (within 24 hours before IVIG treatment) and age-matched fever controls. The single-cell RNA sequencing data of COVID-19, influenza, and health controls were downloaded from the Sequence Read Archive (GSE149689/PRJNA629752). In total, 22 single-cell RNA sequencing data with 102,355 nuclei were enrolled in this study. After performing hierarchical and functional clustering analyses, two enriched gene clusters demonstrated similar patterns in severe COVID-19 and KD, heightened neutrophil activation, and decreased MHC class II expression. Furthermore, comparable dysregulation of neutrophilic granulopoiesis representing two pronounced hyperinflammatory states was demonstrated, which play a critical role in the overactivated and defective aging program of granulocytes, in patients with KD as well as those with severe COVID-19. In conclusion, both neutrophil activation and MHC class II reduction play a crucial role and thus may provide potential treatment targets for KD and severe COVID-19.
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Affiliation(s)
- Kuang-Den Chen
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- nstitute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Sheng Wu
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Sai Chang
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Lun Chu
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- *Correspondence: Ho-Chang Kuo, ;
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Stock AT, Parsons S, Sharma VJ, James F, Starkey G, D'Costa R, Gordon CL, Wicks IP. Intimal macrophages develop from circulating monocytes during vasculitis. Clin Transl Immunology 2022; 11:e1412. [PMID: 35991774 PMCID: PMC9375838 DOI: 10.1002/cti2.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/12/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Vasculitis is characterised by inflammation of the blood vessels. While all layers of the vessel can be affected, inflammation within the intimal layer can trigger thrombosis and arterial occlusion and is therefore of particular clinical concern. Given this pathological role, we have examined how intimal inflammation develops by exploring which (and how) macrophages come to populate this normally immune‐privileged site during vasculitis. Methods We have addressed this question for Kawasaki disease (KD), which is a type of vasculitis in children that typically involves the coronary arteries. We used confocal microscopy and flow cytometry to characterise the macrophages that populate the coronary artery intima in KD patient samples and in a mouse model of KD, and furthermore, have applied an adoptive transfer system to trace how these intimal macrophages develop. Results In KD patients, intimal hyperplasia coincided with marked macrophage infiltration of the coronary artery intima. Phenotypic analysis revealed that these ‘intimal macrophages’ did not express markers of resident cardiac macrophages, such as Lyve‐1, and instead, were uniformly positive for the chemokine receptor Ccr2, suggesting a monocytic lineage. In support of this origin, we show that circulating monocytes directly invade the intima via transluminal migration during established disease, coinciding with the activation of endothelial cells lining the coronary arteries. Conclusions During KD, intimal macrophages develop from circulating monocytes that infiltrate the inflamed coronary artery intima by transluminal migration.
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Affiliation(s)
- Angus T Stock
- Walter and Eliza Hall Institute of Medical Research Parkville VIC Australia
| | - Sarah Parsons
- Department of Forensic Medicine Monash University Melbourne VIC Australia.,Victorian Institute of Forensic Medicine Melbourne VIC Australia
| | - Varun J Sharma
- Liver & Intestinal Transplant Unit Austin Health Melbourne VIC Australia.,Department of Surgery The University of Melbourne, Austin Health Melbourne VIC Australia.,Department of Cardiac Surgery Austin Health Melbourne VIC Australia
| | - Fiona James
- Department of Infectious Diseases Austin Health Melbourne VIC Australia
| | - Graham Starkey
- Liver & Intestinal Transplant Unit Austin Health Melbourne VIC Australia.,Department of Surgery The University of Melbourne, Austin Health Melbourne VIC Australia
| | - Rohit D'Costa
- DonateLife Victoria Carlton VIC Australia.,Department of Intensive Care Medicine Melbourne Health Melbourne VIC Australia
| | - Claire L Gordon
- Department of Infectious Diseases Austin Health Melbourne VIC Australia.,Department of Microbiology and Immunology The Peter Doherty Institute for Infection and Immunity, The University of Melbourne Melbourne VIC Australia.,North Eastern Public Health Unit Austin Health Melbourne VIC Australia
| | - Ian P Wicks
- Walter and Eliza Hall Institute of Medical Research Parkville VIC Australia.,Rheumatology Unit The Royal Melbourne Hospital Melbourne VIC Australia.,Department of Medical Biology University of Melbourne Melbourne VIC Australia
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8
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Zheng Y, Huang S, Zhang J, Hou J, Wu F, Wang W, Han X, Gui Y. Melatonin alleviates vascular endothelial cell damage by regulating an autophagy-apoptosis axis in Kawasaki disease. Cell Prolif 2022; 55:e13251. [PMID: 35582751 PMCID: PMC9201377 DOI: 10.1111/cpr.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/09/2022] [Accepted: 04/24/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives Melatonin has been reported to be an appropriate candidate for mitigating various cardiovascular injuries, owing to its versatility. This study aimed to explore the role of melatonin in Kawasaki disease (KD)‐associated vasculitis and its underlying mechanisms. Material and Methods The role of melatonin was evaluated in human coronary artery endothelial cells (HCAECs), peripheral blood mononuclear cells from KD patients, human THP1 cell line in vitro, and a Candida albicans water‐soluble fraction (CAWS)‐induced KD mouse model in vivo. Cell proliferation assay, cell apoptosis assay, cell co‐culture, RNA extraction, RNA sequencing, reverse transcription quantitative PCR, enzyme‐linked immunosorbent assay (ELISA), transwell assay, western blot, dual‐luciferase reporter assay, and autophagic flux assay were performed to investigate the function and regulatory mechanisms of melatonin in vitro, while haematoxylin and eosin staining, Verhoeff's van Gieson staining, ELISA, and immunohistochemical analysis were performed to detect the effect of melatonin in vivo. Results Melatonin suppressed cell apoptosis directly reduced the expression of endothelial cell damage markers in HCAECs, and alleviated vasculitis in the CAWS‐induced KD mouse model. Mechanistically, melatonin promoted autophagy by activating the melatonin/ melatonin receptor (MT)/cAMP‐response element binding protein (CREB) pathway and upregulating the expression of autophagy‐related gene‐3, thereby suppressing cell apoptosis in an autophagy‐dependent manner. Additionally, melatonin decreased the production of pro‐inflammatory cytokines in macrophages and indirectly reduced the immunopathological damage of HCAECs. Conclusions This study revealed that melatonin protects vascular endothelial cells in KD, by suppressing cell apoptosis in an autophagy‐dependent manner and reducing the immunopathological damage mediated by macrophages.
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Affiliation(s)
- Yuanzheng Zheng
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
| | - Saihua Huang
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.,Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, Fudan University, Shanghai, China
| | - Jialing Zhang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
| | - Jia Hou
- Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Wu
- Department of Neonatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenji Wang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
| | - Xiao Han
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.,Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, Fudan University, Shanghai, China
| | - Yonghao Gui
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
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Nakayama H, Inada H, Inukai T, Kondo K, Hirai K, Tsutsumi T, Adachi Y, Nagi-Miura N, Ohno N, Suzuki K. Recombinant Human Soluble Thrombomodulin Suppresses Arteritis in a Mouse Model of Kawasaki Disease. J Vasc Res 2021; 59:176-188. [PMID: 34929700 DOI: 10.1159/000520717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Kawasaki disease (KD) is associated with diffuse and systemic vasculitis of unknown aetiology and primarily affects infants and children. Intravenous immunoglobulin (IVIG) treatment reduces the risk of developing coronary aneurysms, but some children have IVIG-resistant KD, which increases their risk of developing coronary artery injury. Here, we investigated the effect of recombinant human soluble thrombomodulin (rTM), which has anticoagulant, anti-inflammatory, and cytoprotective properties on the development of coronary arteritis in a mouse model of vasculitis. METHODS An animal model of KD-like vasculitis was created by injecting mice with Candida albicans water-soluble fraction (CAWS). This model was used to investigate the mRNA expression of interleukin (IL)-10, tumour necrosis factor alpha (TNF-α), and tissue factor (TF), in addition to histopathology of heart tissues. RESULTS rTM treatment significantly reduces cardiac vascular endothelium hypertrophy by 34 days after CAWS treatment. In addition, mRNA expression analysis revealed that rTM administration increased cardiac IL-10 expression until day 27, whereas expression of TNF-α was unaffected. Moreover, in the spleen, rTM treatment restores IL-10 and TF expression to normal levels. CONCLUSION These findings suggest that rTM suppresses CAWS-induced vasculitis by upregulating IL-10. Therefore, rTM may be an effective treatment for KD.
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Affiliation(s)
- Hironobu Nakayama
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Hiroyasu Inada
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Tatsuya Inukai
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan.,Department of Microbiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Kenta Kondo
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan.,Medicine Department, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Kazuyuki Hirai
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Tomonari Tsutsumi
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Yoshiyuki Adachi
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Noriko Nagi-Miura
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Naohito Ohno
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Koji Suzuki
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
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10
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Lun Y, Borjini N, Miura NN, Ohno N, Singer NG, Lin F. CDCP1 on Dendritic Cells Contributes to the Development of a Model of Kawasaki Disease. THE JOURNAL OF IMMUNOLOGY 2021; 206:2819-2827. [PMID: 34099547 DOI: 10.4049/jimmunol.2001406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022]
Abstract
The etiology and pathology of Kawasaki disease (KD) remain elusive. Cub domain-containing protein 1 (CDCP1), a cell-surface protein that confers poor prognosis of patients with certain solid tumors, was recently identified as one of the most significantly upregulated genes in SARS-CoV-2-infected children who developed systemic vasculitis, a hallmark of KD. However, a potential role of CDCP1 in KD has not previously been explored. In this study, we found that CDCP1 knockout (KO) mice exhibited attenuated coronary and aortic vasculitis and decreased serum Candida albicans water-soluble fraction (CAWS)-specific IgM/IgG2a and IL-6 concentrations compared with wild-type mice in an established model of KD induced by CAWS administration. CDCP1 expression was not detectable in cardiomyocytes, cardio fibroblasts, or coronary endothelium, but constitutive expression of CDCP1 was observed on dendritic cells (DCs) and was upregulated by CAWS stimulation. CAWS-induced IL-6 production was significantly reduced in CDCP1 KO DCs, in association with impaired Syk-MAPK signaling pathway activation. These novel findings suggest that CDCP1 might regulate KD development by modulating IL-6 production from DCs via the Syk-MAPK signaling pathway.
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Affiliation(s)
- Yu Lun
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Vascular Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Nozha Borjini
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Noriko N Miura
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Science, Hachioji, Tokyo, Japan; and
| | - Naohito Ohno
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Science, Hachioji, Tokyo, Japan; and
| | - Nora G Singer
- Division of Rheumatology, MetroHealth Medical Center, Cleveland, OH
| | - Feng Lin
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA;
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Porritt RA, Chase Huizar C, Dick EJ, Kumar S, Escalona R, Gomez AC, Marek-Iannucci S, Noval Rivas M, Patterson J, Forsthuber TG, Arditi M, Gorelik M. Inhibition of IL-6 in the LCWE Mouse Model of Kawasaki Disease Inhibits Acute Phase Reactant Serum Amyloid A but Fails to Attenuate Vasculitis. Front Immunol 2021; 12:630196. [PMID: 33897686 PMCID: PMC8064710 DOI: 10.3389/fimmu.2021.630196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
Objective Kawasaki disease (KD) is the most common cause of acquired pediatric heart disease in the developed world. 10% of KD patients are resistant to front-line therapy, and no interventions exist to address secondary complications such as myocardial fibrosis. We sought to identify proteins and pathways associated with disease and anti-IL-1 treatment in a mouse model of KD. Methods Vasculitis was induced via Lactobacillus casei cell wall extract (LCWE) injection in 5-week-old male mice. Groups of mice were injected with LCWE alone, LCWE and IL-1 receptor antagonist anakinra, or saline for controls. Upper heart tissue was assessed by quantitative mass spectrometry analysis. Expression and activation of STAT3 was assessed by immunohistochemistry, immunofluorescence and Western blot, and IL-6 expression by RNA-seq and ELISA. A STAT3 small molecular inhibitor and anti-IL-6R antibody were used to evaluate the role of STAT3 and IL-6 in disease development. Results STAT3 was highly expressed and phosphorylated in cardiac tissue of LCWE-injected mice, and reduced following anakinra treatment. Il6 and Stat3 gene expression was enhanced in abdominal aorta of LCWE-injected mice and reduced with Anakinra treatment. IL-6 serum levels were enhanced in LCWE-injected mice and normalized by anakinra. However, neither inhibition of STAT3 nor blockade of IL-6 altered disease development. Conclusion Proteomic analysis of cardiac tissues demonstrates differential protein expression between KD-like, control and anakinra treated cardiac tissue. STAT3 and IL-6 were highly upregulated with LCWE and normalized by anakinra treatment. However, both STAT3 and IL-6 were dispensable for disease development indicating they may be bystanders of inflammation.
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Affiliation(s)
- Rebecca A Porritt
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Carol Chase Huizar
- Department of Biology, University of Texas San Antonio, San Antonio, TX, United States
| | - Edward J Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Shyamesh Kumar
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Renee Escalona
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Angela C Gomez
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Stefani Marek-Iannucci
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Magali Noval Rivas
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jean Patterson
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Thomas G Forsthuber
- Department of Biology, University of Texas San Antonio, San Antonio, TX, United States
| | - Moshe Arditi
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mark Gorelik
- Department of Pediatric Allergy, Immunology and Rheumatology, Columbia University Medical Center, New York, NY, United States
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12
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Wu Q, Yang Z, Huang Y, Wang L, Weng R, Yang J. Effect of Activin A on activation status of monocytes in acute-phase Kawasaki disease. Clin Exp Med 2021; 21:407-414. [PMID: 33630201 DOI: 10.1007/s10238-021-00695-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
Kawasaki disease is a kind of self-limited systemic vasculitis involving middle and small arteries, which usually occurs in children under 5 years old. Excessive inflammatory response caused by activation of monocytes is one of the important mechanisms of Kawasaki disease. Activated monocytes secrete large amounts of inflammatory mediators such as TNF-α and IL-1β. Activin A, a member of transforming growth factor-β superfamily, is a multifunctional growth and transforming factor. Several experimental evidences pinpoint that Activin A can regulate multiple biological function of the immune system. However, whether Activin A is involved in regulation of activation of monocytes in Kawasaki disease was not well characterized. Here, this study showed that the expression of Activin A in serum decreased in acute-phase Kawasaki disease. Furthermore, Activin A inhibits activin type IIA receptor, activin type IB receptor, CD86 and CD80 expression in over-activated monocytes. In addition, Activin A inhibited Smad3 expression and NF-κB signaling pathways. Specific function and mechanism of Activin A in acute-phase Kawasaki disease need further study.
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Affiliation(s)
- Qian Wu
- Shenzhen Graduate School, School of Chemical Biology and Biotechnology, State Key Laboratory of Chemical Oncogenomics, Key Laboratory of Chemical Genome, Peking University, Shenzhen, 518055, China.,Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Zhi Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Yanyan Huang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Linlin Wang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Ruohang Weng
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China.
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13
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Takahashi M. NLRP3 inflammasome as a key driver of vascular disease. Cardiovasc Res 2021; 118:372-385. [PMID: 33483732 DOI: 10.1093/cvr/cvab010] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/12/2020] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
NLRP3 (nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3) is an intracellular innate immune receptor that recognizes a diverse range of stimuli derived from pathogens, damaged or dead cells, and irritants. NLRP3 activation causes the assembly of a large multiprotein complex termed the NLRP3 inflammasome, and leads to the secretion of bioactive interleukin (IL)-1β and IL-18 as well as the induction of inflammatory cell death termed pyroptosis. Accumulating evidence indicates that NLRP3 inflammasome plays a key role in the pathogenesis of sterile inflammatory diseases, including atherosclerosis and other vascular diseases. Indeed, the results of the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial demonstrated that IL-1β-mediated inflammation plays an important role in atherothrombotic events and suggested that NLRP3 inflammasome is a key driver of atherosclerosis. In this review, we will summarize the current state of knowledge regarding the role of NLRP3 inflammasome in vascular diseases, in particular in atherosclerosis, vascular injury, aortic aneurysm, and Kawasaki disease vasculitis, and discuss NLRP3 inflammasome as a therapeutic target for these disorders.
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Affiliation(s)
- Masafumi Takahashi
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
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14
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Tang Y, Gang M, Qian W, Ma J, Xu Q, Lv H. Neutropenia Is Not Associated With the Outcomes in Patients With Kawasaki Disease. Front Pediatr 2021; 9:652346. [PMID: 34150684 PMCID: PMC8211881 DOI: 10.3389/fped.2021.652346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: To investigate the outcomes of coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in patients with and without neutropenia during the disease course and to explore the relationships between Δ absolute neutrophils count (ΔANC) and the outcomes. Methods: We retrospectively reviewed the medical records of patients hospitalized in Children's Hospital of Soochow University with a main diagnosis of KD during January 2019 and December 2019. 1:4 propensity score matching was carried out to adjust the baseline characteristics. Smoothed plots and threshold effect analyses were performed to reveal the relationships between ΔANC and the outcomes. Results: Of the 438 patients enrolled, 75 (17.1%) were neutropenia cases and 363 (82.9%) were non-neutropenia cases. Patients with neutropenia were younger, had lower levels of initial ANC, white blood cell (WBC) count and C-reactive protein (CRP). Propensity score matching included 75 neutropenia and 247 non-neutropenia patients. No significant difference was found between neutropenia and non-neutropenia groups regarding CALs, coronary artery aneurysms, irregular coronary lumen, IVIG resistance and days of fever duration. There was a non-linear relationship between ΔANC and IVIG resistance. However, threshold effect analysis showed the incidence of IVIG resistance decreased with increasing ΔANC before the turning point (ΔANC = 1.6) (OR = 0.65, 95% CI = 0.50-0.8.4 P = 0.001). On the other hand, there was a linear relationship between ΔANC and CALs, even after adjusting the confounders (OR = 1.06, 95% CI = 1.02-1.11, P = 0.008). Conclusions: Neutropenia after IVIG was not exactly associated with the outcomes. However, ΔANC was in relation to CALs and IVIG resistance.
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Affiliation(s)
- Yunjia Tang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Miao Gang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Weiguo Qian
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Jin Ma
- Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, China
| | - Qiuqin Xu
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China
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15
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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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16
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Kwon JE, Roh DE, Kim YH. The Impact of Moderate-Dose Acetylsalicylic Acid in the Reduction of Inflammatory Cytokine and Prevention of Complication in Acute Phase of Kawasaki Disease: The Benefit of Moderate-Dose Acetylsalicylic Acid. CHILDREN-BASEL 2020; 7:children7100185. [PMID: 33081227 PMCID: PMC7602855 DOI: 10.3390/children7100185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
Background: Acetylsalicylic acid (ASA) is part of the recommended treatment of Kawasaki disease (KD). Controversies remain regarding the optimal dose of ASA. We aimed to evaluate the impact of different doses of ASA on inflammation control while minimizing adverse effects in the acute phase treatment of KD. Methods: The enrolled 323 patients with KD were divided into three groups according to ASA dose: moderate-dose (30–50 mg/kg/day), high-dose (80–100 mg/kg/day), and non-ASA. Results: High-dose ASA group showed a significantly shorter duration of fever from the start of treatment to remission than other groups. Baseline level and delta score of interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α, and transforming growth factor β were not statistically different among the groups. The number of patients who received additional treatments in the non-ASA group was more than other groups. Coronary artery dilatation was not significantly different among the groups. One patient with high-dose ASA was diagnosed with Reye syndrome. Conclusion: Different doses of ASA did not show any differences in changes of inflammatory bio-makers and cytokines. However, high-dose ASA showed occurrence of Reye syndrome, and non-ASA showed intravenous immunoglobulin refractoriness. We suggest that moderate-dose ASA may be beneficial for the treatment of patients in the acute phase of KD.
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17
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Inoue T, Murakami S, Matsumoto K, Matsuda A. Functional benefits of corticosteroid and IVIG combination therapy in a coronary artery endothelial cell model of Kawasaki disease. Pediatr Rheumatol Online J 2020; 18:76. [PMID: 33023630 PMCID: PMC7539408 DOI: 10.1186/s12969-020-00461-6] [Citation(s) in RCA: 4] [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: 02/29/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the most common pediatric systemic vasculitides of unknown etiology. Recent clinical studies led to reappraisal of the usefulness of initial combination therapy of intravenous immunoglobulin (IVIG) plus a corticosteroid for patients with severe KD. However, the molecular mechanisms underlying the clinical benefits of that combination therapy remain unclear. Here, we used cultured human coronary artery endothelial cells (HCAECs), as a mimic of KD, to study the possible mechanisms responsible for the clinical benefits of adding a corticosteroid to standard IVIG therapy for patients with severe KD. METHODS HCAECs were stimulated with TNF-α, IL-1α or IL-1β in the presence and absence of high-dose IgG and/or dexamethasone (DEX). The mRNA and protein concentrations for high-mobility group box-1 (HMGB1), IL-1α, IL-6 and granulocyte-colony stimulating factor (G-CSF) in the culture supernatants were measured by quantitative PCR (qPCR) and ELISA, respectively. Apoptosis was evaluated by the caspase 3/7 activities. RESULTS DEX, but not IgG, significantly inhibited apoptosis caused by inflammatory stimuli, resulting in effective reduction of HMGB1 and IL-1α protein release by HCAECs. As previously reported, DEX or IgG alone significantly suppressed TNF-α-induced production of IL-6 and G-CSF and mRNA expression, but induction of those cytokines by IL-1 s (IL-1α and IL-1β) was resistant to high-dose IgG. CONCLUSIONS A corticosteroid can effectively inhibit the release of HMGB1 and IL-1α, which may be involved in IVIG resistance in KD. Since high-dose IgG does not have such beneficial anti-cytotoxic effects, adding a corticosteroid to standard IVIG therapy may help prevent the progression of IVIG resistance in KD.
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Affiliation(s)
- Takashi Inoue
- grid.63906.3a0000 0004 0377 2305Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535 Japan ,grid.411898.d0000 0001 0661 2073Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Shokei Murakami
- grid.63906.3a0000 0004 0377 2305Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535 Japan ,grid.267346.20000 0001 2171 836XDepartment of Pediatrics, Toyama University School of Medicine, Toyama, Japan
| | - Kenji Matsumoto
- grid.63906.3a0000 0004 0377 2305Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535 Japan
| | - Akio Matsuda
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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18
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Kawasaki Disease and Multisystem Inflammatory Syndrome in Children with COVID-19. ACTA ACUST UNITED AC 2020; 2:2096-2101. [PMID: 33043252 PMCID: PMC7538055 DOI: 10.1007/s42399-020-00558-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
Since December 2019, the world has been exposed to a novel virus from the coronaviruses family, named coronavirus disease 2019 (COVID-19), which has affected the life of millions people around the world. This global pandemic causes a wide spectrum of clinical manifestation in children, adults, and elderly. One side of the spectrum in children is being asymptomatic and the other side is severe inflammatory symptoms. In this article, we describe the clinical manifestations, genetic background, and immune response of children with COVID-19, who are presented with severe multisystem inflammatory syndrome (MIS).
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19
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Wang X, Zhang S, Dong M, Li Y, Zhou Q, Yang L. The proinflammatory cytokines IL-1β and TNF-α modulate corneal epithelial wound healing through p16 Ink4a suppressing STAT3 activity. J Cell Physiol 2020; 235:10081-10093. [PMID: 32474927 DOI: 10.1002/jcp.29823] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
Abstract
The proinflammatory cytokines interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) are involved in the corneal inflammatory response and wound healing following corneal injuries. However, the mechanism by which proinflammatory cytokines modulate corneal epithelial wound healing remains unclear. In this study, we found that IL-1β or TNF-α was transiently elevated during corneal epithelial wound healing in mice. After corneal epithelial debridement, persistent treatment with IL-1β or TNF-α restrained the level of phosphorylated signal transducer and activator of transcription 3 (p-STAT3) and boosted the level of cell cycle inhibitor p16Ink4a , resulting in impaired corneal epithelial repair. When p16Ink4a was deleted, the p-STAT3 level in corneal epithelium was enhanced and corneal epithelial wound healing was clearly accelerated. In diabetic mice, IL-1β, TNF-α, and p16Ink4a appeared a sustained and strong expression in the corneal epithelium, and p16Ink4a knockdown partially reverted the defective diabetic corneal epithelial repair. Furthermore, immunoprecipitation proved that p16Ink4a interacted with p-STAT3 and thus possibly suppressed the STAT3 activity. Our findings revealed a novel mechanism that the proinflammatory cytokines modulate corneal epithelial wound healing via the p16Ink4a -STAT3 signaling.
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Affiliation(s)
- Xiaolei Wang
- Medical College, Qingdao University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, China
| | - Songmei Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, China
| | - Muchen Dong
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yunqiu Li
- Jinan Mingshui Eye Hospital, Jinan, China
| | - Qingjun Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, China
| | - Lingling Yang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, China
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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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21
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Tang B, Lo HH, Lei C, U KI, Hsiao WLW, Guo X, Bai J, Wong VKW, Law BYK. Adjuvant herbal therapy for targeting susceptibility genes to Kawasaki disease: An overview of epidemiology, pathogenesis, diagnosis and pharmacological treatment of Kawasaki disease. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2020; 70:153208. [PMID: 32283413 PMCID: PMC7118492 DOI: 10.1016/j.phymed.2020.153208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/17/2020] [Accepted: 03/16/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is a self-limiting acute systemic vasculitis occur mainly in infants and young children under 5 years old. Although the use of acetylsalicylic acid (AAS) in combination with intravenous immunoglobulin (IVIG) remains the standard therapy to KD, the etiology, genetic susceptibility genes and pathogenic factors of KD are still un-elucidated. PURPOSE Current obstacles in the treatment of KD include the lack of standard clinical and genetic markers for early diagnosis, possible severe side effect of AAS (Reye's syndrome), and the refractory KD cases with resistance to IVIG therapy, therefore, this review has focused on introducing the current advances in the identification of genetic susceptibility genes, environmental factors, diagnostic markers and adjuvant pharmacological intervention for KD. RESULTS With an overall update in the development of KD from different aspects, our current bioinformatics data has suggested CASP3, CD40 and TLR4 as the possible pathogenic factors or diagnostic markers of KD. Besides, a list of herbal medicines which may work as the adjunct therapy for KD via targeting different proposed molecular targets of KD have also been summarized. CONCLUSION With the aid of modern pharmacological research and technology, it is anticipated that novel therapeutic remedies, especially active herbal chemicals targeting precise clinical markers of KD could be developed for accurate diagnosis and treatment of the disease.
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Key Words
- AAS, acetylsalicylic acid
- AHA, the American Heart Association
- Adjuvant therapy
- C IVIG, intravenous immunoglobulin
- CALs, coronary artery lesions
- CASP, caspase
- CD, cluster of differentiation
- CRP, C-reactive protein
- DAVID, Database for Annotation, Visualization and Integrated Discovery
- Diagnostic marker
- Epidemiology
- FCGR2A, Fc fragment of immunoglobulin G, low-affinity IIa
- GWAS, genome-wide association method
- HAdV, the human adenovirus
- Herbal chemicals
- IL, Interleukin
- ITPKC, inositol 1,4,5-triphosphate 3-kinase
- KD, Kawasaki disease
- Kawasaki disease
- MyD88, myeloid differentiation factor 88
- NF-κB, nuclear factor κB
- RS, Reye's syndrome
- SNPs, single nucleotide polymorphisms
- Susceptibility genes
- TCMs, traditional Chinese medicines
- TLR4, toll-like receptor 4
- TNF, tumor necrosis factor
- Th, T helper
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Affiliation(s)
- Bin Tang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Hang Hong Lo
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Cheng Lei
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - Ka In U
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - Wen-Luan Wendy Hsiao
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Xiaoling Guo
- South Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, China
| | - Jun Bai
- South Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, China
| | - Vincent Kam-Wai Wong
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Betty Yuen-Kwan Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
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22
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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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The role of Ca 2+/NFAT in Dysfunction and Inflammation of Human Coronary Endothelial Cells induced by Sera from patients with Kawasaki disease. Sci Rep 2020; 10:4706. [PMID: 32170198 PMCID: PMC7069934 DOI: 10.1038/s41598-020-61667-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/26/2020] [Indexed: 12/14/2022] Open
Abstract
Ca2+/nuclear factor of activated T-cells (Ca2+/NFAT) signaling pathway may play a crucial role in the pathogenesis of Kawasaki disease (KD). We investigated the poorly understood Ca2+/NFAT regulation of coronary artery endothelial cells and consequent dysfunction in KD pathogenesis. Human coronary artery endothelial cells (HCAECs) stimulated with sera from patients with KD, compared with sera from healthy children, exhibited significant increases in proliferation and angiogenesis, higher levels of NFATc1 and NFATc3 and some inflammatory molecules, and increased nuclear translocation of NFATc1 and NFATc3. HCAECs stimulated with sera from patients with KD treated with cyclosporine A (CsA) showed decreased proliferation, angiogenesis, NFATc1 and inflammatory molecules levels as compared with results for untreated HCAECs. In conclusion, our data reveal that KD sera activate the Ca2+/NFAT in HCAECs, leading to dysfunction and inflammation of endothelial cells. CsA has cytoprotective effects by ameliorating endothelial cell homeostasis via Ca2+/NFAT.
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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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Anzai F, Watanabe S, Kimura H, Kamata R, Karasawa T, Komada T, Nakamura J, Nagi-Miura N, Ohno N, Takeishi Y, Takahashi M. Crucial role of NLRP3 inflammasome in a murine model of Kawasaki disease. J Mol Cell Cardiol 2019; 138:185-196. [PMID: 31836541 DOI: 10.1016/j.yjmcc.2019.11.158] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is a systemic febrile syndrome during childhood that is characterized by coronary arteritis. The etiopathogenesis of KD remains to be elucidated. NLRP3 inflammasome is a large multiprotein complex that plays a key role in IL-1β-driven sterile inflammatory diseases. In the present study, we investigated the role of NLRP3 inflammasome in a murine model of KD induced by Candida albicans water-soluble fraction (CAWS) and found that NLRP3 inflammasome is required for the development of CAWS-induced vasculitis. CAWS administration induced IL-1β production, caspase-1 activation, leukocyte infiltration, and fibrotic changes in the aortic root and coronary arteries, which were significantly inhibited by a deficiency of IL-1β, NLRP3, and ASC. In vitro experiments showed that among cardiac resident cells, macrophages, but not endothelial cells or fibroblasts, expressed Dectin-2, but did not produce IL-1β in response to CAWS. In contrast, CAWS induced caspase-1 activation and IL-1β production in bone marrow-derived dendritic cells (BMDCs), which were inhibited by a specific caspase-1 inhibitor and a deficiency of NLRP3, ASC, and caspase-1. CAWS induced NLRP3 and pro-IL-1β expression through a Dectin-2/Syk/JNK/NF-κB pathway, and caspase-1 activation and cleavage of pro-IL-1β through Dectin-2/Syk/JNK-mediated mitochondrial ROS generation, indicating that CAWS induces the priming and activation of NLRP3 inflammasome in BMDCs. These findings provide new insights into the pathogenesis of KD vasculitis, and suggest that NLRP3 inflammasome may be a potential therapeutic target for KD.
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Affiliation(s)
- Fumiya Anzai
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Sachiko Watanabe
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiroaki Kimura
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryo Kamata
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Tadayoshi Karasawa
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Takanori Komada
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Jun Nakamura
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Noriko Nagi-Miura
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan
| | - Naohito Ohno
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masafumi Takahashi
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan.
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