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Li NC, Iannuzo N, Christenson SA, Langlais PR, Kraft M, Ledford JG, Li X. Investigation of lactotransferrin messenger RNA expression levels as an anti-type 2 asthma biomarker. J Allergy Clin Immunol 2024:S0091-6749(24)00524-4. [PMID: 38797239 DOI: 10.1016/j.jaci.2024.05.013] [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: 09/12/2023] [Revised: 02/15/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Lactotransferrin (LTF) has an immunomodulatory function, and its expression levels are associated with asthma susceptibility. OBJECTIVES We sought to investigate LTF messenger RNA (mRNA) expression levels in human bronchial epithelial cells (BECs) as an anti-type 2 (T2) asthma biomarker. METHODS Association analyses between LTF mRNA expression levels in BECs and asthma-related phenotypes were performed in the Severe Asthma Research Program (SARP) cross-sectional (n = 155) and longitudinal (n = 156) cohorts using a generalized linear model. Correlation analyses of mRNA expression levels between LTF and all other genes were performed by Spearman correlation. RESULTS Low LTF mRNA expression levels were associated with asthma susceptibility and severity (P < .025), retrospective and prospective asthma exacerbations, and low lung function (P < 8.3 × 10-3). Low LTF mRNA expression levels were associated with high airway T2 inflammation biomarkers (sputum eosinophils and fractional exhaled nitric oxide; P < 8.3 × 10-3) but were not associated with blood eosinophils or total serum IgE. LTF mRNA expression levels were negatively correlated with expression levels of TH2 or asthma-associated genes (POSTN, NOS2, and MUC5AC) and eosinophil-related genes (IL1RL1, CCL26, and IKZF2) and positively correlated with expression levels of TH1 and inflammation genes (IL12A, MUC5B, and CC16) and TH17-driven cytokines or chemokines for neutrophils (CXCL1, CXCL6, and CSF3) (P < 3.5 × 10-6). CONCLUSIONS Low LTF mRNA expression levels in BECs are associated with asthma susceptibility, severity, and exacerbations through upregulation of airway T2 inflammation. LTF is a potential anti-T2 biomarker, and its expression levels may help determine the balance of eosinophilic and neutrophilic asthma.
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Affiliation(s)
- Nicholas C Li
- University of Arizona Internship, Basis Tucson North, Tucson, Ariz
| | - Natalie Iannuzo
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Ariz
| | - Stephanie A Christenson
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of California, San Francisco, Calif
| | - Paul R Langlais
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, Ariz
| | - Monica Kraft
- Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie G Ledford
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Ariz
| | - Xingnan Li
- Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, Ariz.
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Ding H, Shi Z, Lin H, Sun Y, Zhang L, Liu F, Wang X, Zhang Z, Zhang G. Serum proteomics identifies novel diagnostic biomarkers for asthma in preschool children. J Thorac Dis 2024; 16:65-80. [PMID: 38410598 PMCID: PMC10894366 DOI: 10.21037/jtd-23-974] [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: 06/19/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background Asthma is characterized by airway hyperresponsiveness, reversible airway obstruction, and chronic airway inflammation. It is the most common chronic disease in childhood. However, the diagnosis of childhood asthma remains challenging, and there is an urgent need to develop new diagnostic methods. Methods To identify biomarkers of asthma in children, we adopted the Orbitrap-based data-independent acquisition (DIA) mass spectrometry proteomics method to analyze the serum proteomic signatures of children with acute asthma and convalescent children. Results We identified 747 proteins in 46 serum samples and 50 differentially expressed proteins (DEPs) that distinguished between asthmatic and healthy children. Next, functional enrichment analysis of the DEPs was conducted, it was indicated that the DEPs were significantly enriched in immune-related and function terms and pathways. Furthermore, we performed statistical analysis and identified MMP14, ABHD12B, PCYOX1, LTBP1, CFHR4, APOA1, IGHG4, ANG and IGFALS proteins as the diagnostic biomarker candidates. Ultimately, a promising asthma diagnostic model for preschool children based on IGFALS was built and evaluated. The area under the curve (AUC) of the IGFALS model was 0.959. Conclusions In this study, the DIA proteome strategy was used and the largest number of proteins of asthmatic children serum proteomics was identified. The proteomics results showed that the DEPs play the central role of the inflammation-immune mechanism in asthma pathogenesis, suggesting that these proteins may be used in asthma diagnosis, prognosis, or therapy, and suggested biomarkers for asthma of preschool children. In conclusion, our results provide insight into the pathophysiology of asthma. We believe that the diagnostic model will facilitate clinical decision-making regarding asthma in preschool children.
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Affiliation(s)
| | | | - Haibo Lin
- Department of Pediatrics, Children’s Hospital, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yuan Sun
- Department of Pediatrics, Children’s Hospital, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lu Zhang
- Department of Pediatrics, Children’s Hospital, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Feiyan Liu
- Department of Pediatrics, Children’s Hospital, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xuelin Wang
- Department of Pediatrics, Children’s Hospital, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Zhihong Zhang
- Department of Pediatrics, Children’s Hospital, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
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Israel A, Schäffer AA, Berkovitch M, Ozeri DJ, Merzon E, Green I, Golan-Cohen A, Ruppin E, Vinker S, Magen E. Glucose-6-phosphate dehydrogenase deficiency and long-term risk of immune-related disorders. Front Immunol 2023; 14:1232560. [PMID: 37753082 PMCID: PMC10518697 DOI: 10.3389/fimmu.2023.1232560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked enzymatic disorder that is particularly prevalent in Africa, Asia, and the Middle East. This study aimed to assess the long-term health risks associated with G6PD deficiency. Methods A retrospective cohort study was conducted using data from a national healthcare provider in Israel (Leumit Health Services). A total of 7,473 G6PD-deficient individuals were matched with 29,892 control subjects in a 1:4 ratio, based on age, gender, socioeconomic status, and ethnic groups. The exposure of interest was recorded G6PD diagnosis or positive G6PD diagnostic test. The main outcomes and measures included rates of infectious diseases, allergic conditions, and autoimmune disorders between 2002 and 2022. Results Significantly increased rates were observed for autoimmune disorders, infectious diseases, and allergic conditions in G6PD-deficient individuals compared to the control group. Specifically, notable increases were observed for rheumatoid arthritis (odds ratio [OR] 2.41, p<0.001), systemic lupus erythematosus (OR 4.56, p<0.001), scleroderma (OR 6.87, p<0.001), pernicious anemia (OR 18.70, p<0.001), fibromyalgia (OR 1.98, p<0.001), Graves' disease (OR 1.46, p=0.001), and Hashimoto's thyroiditis (OR 1.26, p=0.001). These findings were supported by elevated rates of positive autoimmune serology and higher utilization of medications commonly used to treat autoimmune conditions in the G6PD-deficient group. Discussion In conclusion, individuals with G6PD deficiency are at a higher risk of developing autoimmune disorders, infectious diseases, and allergic conditions. This large-scale observational study provides valuable insights into the comprehensive association between G6PD deficiency and infectious and immune-related diseases. The findings emphasize the importance of considering G6PD deficiency as a potential risk factor in clinical practice and further research is warranted to better understand the underlying mechanisms of these associations.
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Affiliation(s)
- Ariel Israel
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- School of Public Health and Family Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Alejandro A. Schäffer
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD, United States
| | - Matitiahu Berkovitch
- School of Public Health and Family Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, Israel
| | - David J. Ozeri
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- Division of Rheumatology, Sheba Medical Center, Ramat Gan, Israel
| | - Eugene Merzon
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ilan Green
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- School of Public Health and Family Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Avivit Golan-Cohen
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- School of Public Health and Family Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD, United States
| | - Shlomo Vinker
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- School of Public Health and Family Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Eli Magen
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo, Israel
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel
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Israel A, Schäffer AA, Berkovitch M, Ozeri DJ, Merzon E, Green I, Golan-Cohen A, Ruppin E, Vinker S, Magen E. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Long-Term Risk of Immune-Related diseases. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.23.23287616. [PMID: 37090544 PMCID: PMC10120794 DOI: 10.1101/2023.03.23.23287616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive enzymatic disorder, particularly prevalent in Africa, Asia and the Middle East. In the US, about 14% of black men are affected. Individuals with G6PD deficiency are often asymptomatic but may develop hemolysis following an infection or upon consumption of specific medications. Despite some evidence that G6PD deficiency affects the immune system, the long- term health risks associated with G6PD deficiency had not been studied in a large population. METHODS In this retrospective cohort study, health records from G6PD deficient individuals were compared to matched controls in a national healthcare provider in Israel (Leumit Health Services). Rates of infectious diseases, allergic conditions and autoimmune disorders were compared between groups. RESULTS The cohort included 7,473 G6PD deficient subjects (68.7% men) matched with 29,892 control subjects (4:1 ratio) of the same age, gender, socioeconomic status and ethnic group, followed during 14.3±6.2 years.Significantly increased rates for autoimmune disorders, infectious diseases and allergic conditions were observed throughout this period. Notable increases were observed for rheumatoid arthritis (OR 2.41, p<0.001), systemic lupus erythematosus (OR 4.56, p<0.001), scleroderma (OR 6.87, p<0.001), pernicious anemia (OR=18.70, P<0.001), fibromyalgia (OR 1.98, p<0.001), Graves' disease (OR 1.46, P=0.001), and Hashimoto's thyroiditis (OR 1.26, P=0.001). These findings were corroborated with elevated rates of positive autoimmune serology and higher rates of treatment with medications commonly used to treat autoimmune conditions in the G6PD deficient group. CONCLUSION G6PD deficient individuals suffer from higher rates of autoimmune disorders, infectious diseases, and allergic conditions.
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Affiliation(s)
- Ariel Israel
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801 Israel
| | - Alejandro A Schäffer
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - David J. Ozeri
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Division of Rheumatology, Sheba Medical Center
| | - Eugene Merzon
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel
| | - Ilan Green
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801 Israel
| | - Avivit Golan-Cohen
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801 Israel
| | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA
| | - Shlomo Vinker
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801 Israel
| | - Eli Magen
- Leumit Research Institute, Leumit Health Services, Tel Aviv-Yafo 6473817, Israel
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba 8410501, Israel
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Vizuet-de-Rueda JC, Montero-Vargas JM, Galván-Morales MÁ, Porras-Gutiérrez-de-Velasco R, Teran LM. Current Insights on the Impact of Proteomics in Respiratory Allergies. Int J Mol Sci 2022; 23:ijms23105703. [PMID: 35628512 PMCID: PMC9144092 DOI: 10.3390/ijms23105703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/11/2022] Open
Abstract
Respiratory allergies affect humans worldwide, causing extensive morbidity and mortality. They include allergic rhinitis (AR), asthma, pollen food allergy syndrome (PFAS), aspirin-exacerbated respiratory disease (AERD), and nasal polyps (NPs). The study of respiratory allergic diseases requires new technologies for early and accurate diagnosis and treatment. Omics technologies provide the tools required to investigate DNA, RNA, proteins, and other molecular determinants. These technologies include genomics, transcriptomics, proteomics, and metabolomics. However, proteomics is one of the main approaches to studying allergic disorders' pathophysiology. Proteins are used to indicate normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. In this field, the principal goal of proteomics has been to discover new proteins and use them in precision medicine. Multiple technologies have been applied to proteomics, but that most used for identifying, quantifying, and profiling proteins is mass spectrometry (MS). Over the last few years, proteomics has enabled the establishment of several proteins for diagnosing and treating respiratory allergic diseases.
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Association between Glucose-6-Phosphate Dehydrogenase Deficiency and Asthma. J Clin Med 2021; 10:jcm10235639. [PMID: 34884340 PMCID: PMC8658649 DOI: 10.3390/jcm10235639] [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: 11/03/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Among the determinants contributing to the pathogenesis of asthma, antioxidant genetic factors play a leading role. Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that is competent to detoxify free radicals. Although a relationship between G6PD deficiency and asthma has been previously reported, the literature is still scanty. In this study, we test this hypothesis in a large cohort of patients from Sardinia, Italy. Methods: A retrospective case–control study was performed using data from 11,829 clinical records of outpatients referred to a teaching hospital for a medical visit. In total, 455 cases (asthma-positive) and 11,374 controls (asthma-negative) were compared for G6PD status using multivariable analysis, adjusting for all covariates. Results: Overall, G6PD deficiency was detected in 11.2% of study participants and was associated with an increased risk of asthma (odds ratio (OR) 1.63; 95% confidence interval (CI) 1.27–2.10). Additional variables significantly associated with asthma were female sex (OR 1.66; 95% CI 1.34–2.06), overweight/obesity (OR 1.56; 95% CI 1.27–1.92), smoking (OR 1.44; 95% CI 1.449–3.963), and high socioeconomic status (OR 1.40; 95% CI 1.16–1.70), whereas age was inversely related with asthma (OR 0.49; 95% CI 0.39–0.61). Conclusions: Our study shows that G6PD deficiency is an independent risk for asthma. These findings suggest that G6PD should be assessed in asthmatic patients for better risk stratification.
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Xie T, Guo J, Jiang Y, Li L, Jiang L, Wei Y. Screening differentially expressed proteins of coronary heart disease with congenital cold syndrome based on tandem mass tag (TMT) technology. Bioengineered 2021; 12:1338-1350. [PMID: 33904367 PMCID: PMC8806272 DOI: 10.1080/21655979.2021.1912546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In our previous studies, we discovered the congenital cold syndrome (CCS), which is characterized by 'qi deficiency and qi stagnation, mixed cold and heat.' And there is a type of syndrome with special incidence characteristic. However, the diagnosis of CCS still lacks an objective basis. In this study, we performed Tandem Mass Tag (TMT) based on quantitative proteomics technology to screen the significantly differentially expressed proteins (DEPs) in serum of patients with coronary heart disease (CHD) patients with CCS, patients with heart and kidney yang deficiency, and healthy people. A total of 22 DEPs (nine upregulated and 13 downregulated) were identified between patients with CCS and healthy subjects. Next, we performed GO and KEGG pathway enrichment analysis, we found the primary functions of DEPs of CCS were binding, catalytic activity, and molecular function regulator. These DEPs were mainly involved in important biological processes, such as cellular process, response to stimulus, localization, metabolic process, and biological regulation. The KEGG analysis revealed that the DEPs showed significant changes in fructose and mannose metabolism, Pentose phosphate pathway, and Arrhythmogenic right ventricular cardiomyopathy. After parallel reaction monitoring (PRM) verification, four upregulated target proteins (ALDOA, PCYOX1, Crisp3 and IGLV4-69) and three downregulated proteins (ALDOC, ADAMTSL-2 and C3) were accurately identified. These proteins were mainly related to immune response and glucose metabolism. These DEPs could be the marker proteins of coronary heart disease with CCS. This findings help to reveal the pathogenesis of CHD with CCS and provide potential therapeutic targets.
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Affiliation(s)
- Tingting Xie
- Changchun University of Chinese Medicine, College of traditional Chinese medicine, Changchun, China
| | - Jiajuan Guo
- Department of cardiovascular medicine, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Yanshu Jiang
- The first clinical hospital of Jilin Province Academy of Traditional Chinese Medicine, Department of orthopedic, Changchun, China
| | - Lijie Li
- Changchun University of Chinese Medicine, College of traditional Chinese medicine, Changchun, China
| | - Lihong Jiang
- Department of cardiovascular medicine, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Yan Wei
- Changchun University of Chinese Medicine, College of Basic Medicine, Changchun, China
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Shi Y, Yang W, Tang X, Yan Q, Cai X, Wu F. Keshan Disease: A Potentially Fatal Endemic Cardiomyopathy in Remote Mountains of China. Front Pediatr 2021; 9:576916. [PMID: 33768083 PMCID: PMC7985175 DOI: 10.3389/fped.2021.576916] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/25/2021] [Indexed: 12/16/2022] Open
Abstract
Keshan disease (KD) as an endemic, highly lethal cardiomyopathy, first reported in northeast China's Keshan County in 1935. The clinical manifestations of patients with KD include primarily congestive heart failure, acute heart failure, and cardiac arrhythmia. Even though some possible etiologies, such as viral infection, fungal infection, microelement deficiency, and malnutrition, have been reported, the exact causes of KD remain poorly known. The endemic areas where KD is found are remote and rural, and many are poor and mountainous places where people are the most socioeconomically disadvantaged in terms of housing, income, education, transportation, and utilization of health services. To date, KD is a huge burden to and severely restricts the economic development of the local residents and health systems of the endemic areas. Although efforts have been made by the government to control, treat, and interrupt disease transmission, the cure for or complete eradication of KD still requires global attention. For this reason, in this review, we systematically describe the etiological hypothesis, clinical manifestations, incidence characteristics, and treatment of KD, to facilitate the better understanding of and draw more attention to this non-representative cardiovascular disease, with the aim of accelerating its elimination.
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Affiliation(s)
- Ying Shi
- Department of Central Laboratory, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
| | - Wei Yang
- Department of Physical Examination, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
| | - Xianwen Tang
- Department of Cardiovascular Medicine, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
| | - Quanhao Yan
- Department of Cardiovascular Medicine, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
| | - Xiaojing Cai
- Department of Cardiovascular Medicine, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
| | - Fenfang Wu
- Department of Central Laboratory, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China
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