Decreased levels of inflammatory cytokines in immunoglobulin-resistant Kawasaki disease after plasma exchange

Fujimaru, Takuya; Ito, Shuichi; Masuda, Hiroshi; Oana, Shinji; Kamei, Koichi; Ishiguro, Akira; Kato, Hitoshi; Abe, Jun

doi:10.1016/j.cyto.2014.07.003

Cited by 46 publications

(37 citation statements)

References 30 publications

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“…However, none of the changes in the three inflammatory biomarkers were associated with progressive coronary dilatation. Therefore, additional studies are warranted to elucidate the effects of CRP and other KD-associated inflammatory biomarkers, such as interleukin-4 [26] and interleukin-6 [27], on early and late CALs in patients with KD.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and implications of progressive coronary dilatation in children with Kawasaki disease

Liu

et al. 2017

BMC Pediatr

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Background: Kawasaki disease (KD) is an acute systemic vasculitis that occurs in children and may lead to cardiovascular morbidity and mortality. Progressive coronary dilatation for at least 2 months is associated with worse late coronary outcomes in patients with KD having medium or giant aneurysms. However, the risk factors and occurrence of progressive coronary dilatation in patients with KD but without medium or giant aneurysms have been insufficiently explored. Methods: We retrospectively enrolled 169 patients with KD from a tertiary medical center in Taiwan during [2009][2010][2011][2012][2013]. Medical records of all patients were reviewed. Echocardiography was performed during the acute KD phase and at 3-4 weeks, 6-8 weeks, 6 months, and 12 months after KD onset. Progressive coronary dilatation was defined as the progressive enlargement of coronary arteries on three consecutive echocardiograms. Logistic regression analysis was conducted to evaluate the potential risk factors for coronary aneurysms and progressive coronary dilatation. Results: Of a total of 169 patients with KD, 31 (18.3%) had maximal coronary Z-scores of ≥ + 2.5 during the acute KD phase, 16 (9.5%; male/female: 9/7) had coronary aneurysms at 1 month after KD onset, and 5 (3.0%) satisfied the definition of progressive coronary dilatation. Multivariate logistic regression analysis revealed that an initial maximal coronary Z-score of ≥ + 2.5 [odds ratio (OR): 5.24, 95% confidence interval (CI): 1.31-21.3, P = 0.020] and hypoalbuminemia (OR: 4.83, 95% CI: 1.11-20.9, P = 0.035) were independent risk factors for coronary aneurysms and were significantly associated with progressive coronary dilatation. However, the association between intravenous immunoglobulin unresponsiveness and the development of coronary aneurysms at 1 month after KD onset didn't reach the level of significance (P = 0.058). Conclusions: In the present study, 3% (5/169) of patients with KD had progressive coronary dilatation, which was associated with persistent coronary aneurysms at 1 year after KD onset. Initial coronary dilatation and hypoalbuminemia were independently associated with the occurrence of progressive coronary dilatation. Therefore, such patients may require intensive cardiac monitoring and adjuvant therapies apart from immunoglobulin therapies.

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Section: Discussionmentioning

confidence: 99%

Risk factors and implications of progressive coronary dilatation in children with Kawasaki disease

Liu

et al. 2017

BMC Pediatr

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“…Aspirin is used in conjunction with IVIG for its anti-inflammatory effect in the acute phase of KD and for its anti-platelet activity during the sub-acute phase [63][64]. The accepted dosage varies from country to country.…”

Section: Treatmentmentioning

confidence: 99%

“…The accepted dosage varies from country to country. While in the USA, it is given at a high dose of 80-100 mg/kg/day as per the AHA guidelines, in Japan it is recommended at a moderate dose of 30-50 mg/kg/day given the risk of hepatic toxicity at higher doses [59, 64]. Studies have reported similar efficacy of the two treatment regimen[65].…”

Section: Treatmentmentioning

confidence: 99%

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Kawasaki disease: etiopathogenesis and novel treatment strategies

Agarwal

Agrawal

2016

Expert Review of Clinical Immunology

164

113

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Introduction-Kawasaki disease is an acute febrile systemic vasculitis that predominantly occurs in children below five years of age. Its etiopathogenesis is still not clear, but it is thought to be a complex interplay of genetic factors, infections and immunity.Areas covered-This review article discusses in detail Kawasaki disease, with particular emphasis on the recent updates on its pathogenesis and upcoming alternate treatment options. Though self-limiting in many cases, it can lead to severe complications like coronary artery aneurysms and thrombo-embolic occlusions, and hence requires early diagnosis and urgent attention to avoid them. Intravenous immunoglobulin (IVIG) with or without aspirin has remained the sole treatment option for these cases, but 10-15% cases develop resistance to this treatment.Expert Commentary-There is a need to develop additional treatment strategies for children with Kawasaki disease. Targeting different steps of pathogenesis could provide us with alternate therapeutic options.

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“…It has been reported that elevations in proinflammatory cytokines, such as interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β, are closely related to the pathogenesis of Kawasaki disease [17][18][19]. Fujimura et al reported that IL-6, TNF-α (including TNF receptors 1 and 2), granulocyte colony-stimulating factor, and IL-17 were significantly decreased after plasma exchange treatment [20]. In particular, TNF-α has been shown to be necessary for the development of coronary artery lesions in Kawasaki disease [21].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

et al. 2017

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Background: The treatment of Kawasaki disease is controversial when intravenous immunoglobulin therapy fails, although it typically relies on combinations of prednisolone, infliximab, cyclosporine, and plasma exchange therapy. The goal of the treatment is no longer merely to reduce mortality but also to decrease the sequelae of coronary artery lesions, which are the most common and potentially life-threatening complications. Recently, plasma exchange therapy has been used to treat intravenous immunoglobulin-unresponsive Kawasaki disease with coronary artery lesions. When performed before coronary artery dilatation, the outcomes for plasma exchange are known to be excellent; however, when dilatation is already present, sequelae persist. Methods: Between December 2006 and April 2015, we treated ten patients with Kawasaki disease complicated by coronary artery lesions that received plasma exchange because intravenous immunoglobulin therapy had proven to be ineffective. Here, we retrospectively review the efficacy and safety of plasma exchange therapy in such unresponsive cases against coronary artery lesions in patients with Kawasaki disease when plasma exchange performed after coronary artery dilatation. Results: In nine of the ten patients (90.0%), the body temperature was confirmed to be < 37.5°C at an average of 2.7 ± 1. 4 days after starting plasma exchange. Serum C-reactive protein levels decreased significantly from 9.9 ± 4.9 mg/dL before exchange to 1.9 ± 2.9 mg/dL after exchange (P < 0.05). One year after plasma exchange treatment, the coronary artery lesions had regressed to within normal limits in six of the ten patients. Although lesions remained in three patients, all three of these patients were asymptomatic. In addition, there were no stenosis of the coronary artery in nine of the ten patients. One patient died due to a ruptured giant coronary aneurysm 1 day after starting plasma exchange. Conclusions: In conclusion, plasma exchange may be effective in not only regressing coronary artery lesions but also preventing sequelae in patients with Kawasaki disease when plasma exchange is performed after coronary artery dilatation.

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Decreased levels of inflammatory cytokines in immunoglobulin-resistant Kawasaki disease after plasma exchange

Cited by 46 publications

References 30 publications

Risk factors and implications of progressive coronary dilatation in children with Kawasaki disease

Risk factors and implications of progressive coronary dilatation in children with Kawasaki disease

Kawasaki disease: etiopathogenesis and novel treatment strategies

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

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