Evidence of premature atherosclerosis late after Kawasaki disease (KD) is accumulating. Given the potential roles of monocyte chemoattractant protein-1 (MCP-1), chemokine receptor CCR-2, and inducible nitric oxide synthase (iNOS) in atherogenesis, we sought to determine whether serum obtained from children late after KD would induce expression of these genes in macrophages in vitro. A total of 79 subjects were studied, which comprised 57 KD patients, 33 of whom had coronary aneurysms, and 22 age-matched controls. Expression of MCP-1, CCR2, and iNOS mRNA in THP-1 macrophages in the presence of patient and control serum was quantified as a ratio to -actin mRNA and expressed as a percentage of control. MCP-1 expression was significantly increased in the presence of serum from patients with coronary aneurysms. Expression of CCR2 and iNOS was significantly increased when THP-1 macrophages were incubated with serum from patients with and without coronary aneurysms. The magnitude of induction of MCP-1, CCR2, and iNOS or in combinations correlated positively with serum highsensitivity C-reactive protein (hs-CRP), and low-density lipoprotein (LDL) cholesterol levels and negatively with high-density lipoprotein (HDL) cholesterol level. In conclusion, the serum of patients with a history of KD induces expression of MCP-1, CCR2, and iNOS in THP-1 macrophages in vitro. Induction of these genes in vivo may be related to chronic inflammation and may have important implications for premature atherosclerosis. KD is at present the most common acquired heart disease in children in developed countries (1). It has been more than 25 y since its first description and concerns have been raised regarding the possibility of its predisposition to premature atherosclerosis later in life (2-6). We have previously reported on the adverse cardiovascular risk profile, as characterized by a proatherogenic alteration of lipid profile and increased peripheral conduit arterial stiffness, in children with a history of KD (7). Furthermore, carotid intima-media thickness, a marker of atherosclerosis (8), has been found to be significantly increased in patients studied at about 10 y after the acute illness (9). While there is growing evidence to suggest premature atherosclerosis in patients with a history of KD, the underlying mechanism remains unknown.Inflammatory processes play a pivotal role in atherogenesis (10). Recently, we (11) and the others (12) have provided evidence that low-grade chronic inflammation may continue unabated after the acute phase of KD. One of the important features of atherosclerosis is infiltration of monocytes into the injured arterial wall followed by their differentiation into macrophages (13). Recent evidence suggests that the inflammatory response in vascular injury involves recruitment and activation of monocytes through activation of the MCP-1 (10,14,15), a potent chemotactic factor for monocytes. In both human and experimental animal models (16), expression of the MCP-1 mRNA and protein has been found to be markedl...