Evaluation of intravenous immunoglobulin resistance and coronary artery lesions in relation to Th1/Th2 cytokine profiles in patients with Kawasaki disease.

Abstract

OBJECTIVE:

To investigate the roles of serum Th1 and Th2 cytokines in Kawasaki disease (KD) and determine whether the Th1/Th2 cytokine profiles in children with KD may be involved in intravenous immunoglobulin (IVIG) resistance and development of coronary artery lesions (CALs).

METHODS:

Serum Th1 and Th2 cytokines, including interferon-γ (IFNγ), tumor necrosis factor α (TNFα), interleukin-10 (IL-10), IL-6, IL-4, and IL-2, were measured using a cytometric bead array in the serum of 143 patients with KD before and after treatment with IVIG (pre-IVIG, at 3 days after temperature normalization following IVIG treatment [post-IVIG], and 1 month posttreatment).

RESULTS:

Levels of IL-6, IL-10, TNFα, and IFNγ were significantly increased in KD patients pre-IVIG. Post-IVIG, the levels of IL-6, IL-10, and IFNγ quickly decreased. The levels of TNFα decreased significantly after IVIG treatment in KD patients without CALs post-IVIG and in KD patients who were IVIG responders, but increased slightly in KD patients with CALs post-IVIG and in KD patients who were IVIG nonresponders. Before IVIG treatment, the levels of IL-4, IL-6, IL-10, and IFNγ were significantly higher in KD patients with CALs than in those without CALs. The post-IVIG levels of IL-6 and IL-10 were significantly higher in IVIG nonresponders than in IVIG responders. Pre-IVIG, an IL-10 level >8 pg/ml had a sensitivity of 75.0% and a specificity of 64.4% for predicting CALs, while a TNFα level <2 pg/ml had a sensitivity of 66.7% and a specificity of 74.2% for predicting IVIG resistance. Post-IVIG, an IL-6 level >10 pg/ml had a sensitivity of 67.9% and a specificity of 81.7% for predicting CALs, while an IL-10 level >6 pg/ml had a sensitivity of 53.6% and a specificity of 86% for predicting CALs.

CONCLUSION:

Determination of the serum Th1/Th2 cytokine profile may be helpful for predicting the disease prognosis and targeting treatment strategies in patients with KD.

• Authors: Yujia Wang, Wei Wang, Fangqi Gong, Songling Fu, Qing Zhang, Jian Hu, Yanqi Qi, Chunhong Xie, Yiying Zhang
• Journal: Arthritis and rheumatism (Arthritis Rheum) Vol. 65 Issue 3 Pg. 805-14 (Mar 2013) ISSN: 1529-0131 [Electronic] United States
• PMID: 23440694 (Publication Type: Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 by the American College of Rheumatology.

Chemical References

• Cytokines
• Immunoglobulins, Intravenous

Topics

• Child
• Child, Preschool
• Coronary Artery Disease (diagnosis, drug therapy, immunology)
• Cytokines (blood)
• Drug Resistance (immunology)
• Epstein-Barr Virus Infections (drug therapy, immunology)
• Female
• Humans
• Immunoglobulins, Intravenous (administration & dosage, blood)
• Infant
• Male
• Mucocutaneous Lymph Node Syndrome (diagnosis, drug therapy, immunology)
• Predictive Value of Tests
• Prognosis
• Sensitivity and Specificity
• Sepsis (drug therapy, immunology)
• Th1 Cells (metabolism, pathology)
• Th2 Cells (metabolism, pathology)