Intravenous γ‐Globulin Treatment in Kawasaki Disease

Harada, Kensuke

doi:10.1111/j.1442-200x.1991.tb02612.x

Cited by 230 publications

(158 citation statements)

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“…Thus, circulating levels of PAI-1 and the ratio of PA/PAI-1 complex to PAI-1 may be useful as predictive markers for CAL development in KD. There is controversy over whether high-dose gammaglobulin therapy should be applied to all KD patients (37); consequently, the decision of whether to use gammaglobulin is often based on one of several risk stratification scores for development of CAL (38). PAI-1 level may provide additional information about the risk of CAL development, thus helping determine whether to use gammaglobulin.…”

Section: Discussionmentioning

confidence: 99%

Plasminogen Activator Inhibitor-1 in Patients with Kawasaki Disease: Diagnostic Value for the Prediction of Coronary Artery Lesion and Implication for a New Mode of Therapy

Senzaki¹,

Kobayashi²,

Nagasaka³

et al. 2003

Pediatr Res

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Kawasaki disease (KD) in children takes the form of acute systemic vasculitis, which causes coronary artery dilation and aneurysm formation in 10% to 15% of the patients. We have recently shown that matrix metalloproteinases (MMPs) are intimately involved in coronary arterial wall destruction and the resultant formation of coronary artery lesions (CALs) in this disease. Plasminogen activators (PAs) are known to be a major pathway of MMP activation, and this suggests that their inhibitor, plasminogen activator inhibitor-1 (PAI-1), also plays important roles in the development of CALs in KD. The present study was conducted to test the hypothesis that circulating levels of PAI-I are related to CAL formation in KD. Plasma levels of PAI-1 were measured by enzyme-linked immunoassay in 37 KD patients without CALs (group 1) and 7 KD patients with CALs (group 2). Blood samples were obtained before and after i.v. gammaglobulin therapy (IVGG), and in the convalescent stage. Levels of PAI-1 were significantly higher in KD patients before IVGG than in 18 age-matched healthy control subjects (p Ͻ 0.01). More importantly, both pre-IVGG and post-IVGG levels of PAI-1 were significantly higher in group 2 than in group 1 (p Ͻ 0.01). Furthermore, PAI-1 levels of 9 patients from group 1 who showed pre-IVGG PAI-1 levels higher than the minimum PAI-1 level in group 2 significantly decreased after IVGG, whereas PAI-1 levels of group 2 patients remained persistently elevated, further suggesting a close association between PAI-1 and CAL development in KD. Thus, PAI-1 may be useful as a predictive marker for CAL development in KD. Studies of the effects of PA inhibition on coronary outcome may provide evidence that PA is a viable therapeutic target for the prevention of KD-related CALs. The extracellular matrix of the arterial wall provides a strong structural safety net that resists arterial expansion in a healthy individual. Arterial aneurysm development is thought to be the consequence of degradation of these structural proteins by proteolytic enzymes derived mainly from inflammatory cells infiltrating into media and adventitia (1-3). Matrix metalloproteinases (MMPs) have been implicated in this degradation process, and are thought to play dominant roles in the formation of abdominal aortic aneurysms (3-6).Plasminogen activators (PAs) and plasmin (a serine protease) are known to be activated in response to several inflammatory conditions and to act as triggers activating the MMP pathway (7,8). In addition, recent study of aortic aneurysm in a rat model has demonstrated that blocking PA activity via local overexpression of plasminogen activator inhibitor-1 (PAI-1) prevents formation of arterial aneurysms by inhibiting MMP activation, suggesting a critical role for PA-mediated MMP activation in arterial wall destruction and resultant aneurysm formation (6, 9).Kawasaki disease (KD) in children takes the form of acute systemic vasculitis, which causes coronary artery dilation and aneurysm formation in 10% to 15% of patients during its acute

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Section: Discussionmentioning

confidence: 99%

Plasminogen Activator Inhibitor-1 in Patients with Kawasaki Disease: Diagnostic Value for the Prediction of Coronary Artery Lesion and Implication for a New Mode of Therapy

Senzaki¹,

Kobayashi²,

Nagasaka³

et al. 2003

Pediatr Res

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“…Consequently, the effusion and other symptoms ameliorated without IVIG administration reducing treatment costs. We thus presumed that the scoring system was useful in assessing the need for IVIG in AKD patients as well as childhood KD patients (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…At that time, the patient fulfilled five of the diagnostic criteria for KD (12): 1) fever lasting more than 5 days; 2) erythema and peeling of the skin at the extremities (plate-like desquamation of the palms and soles); 3) heterogenous erythema; 4) conjunctival hyperemia; and 5) strawberry tongue. According to the Harada scoring system (5,13,14), she fulfilled only one criterion (CRP elevation) ( Table 2). We thus withheld administration of intravenous immunoglobulin (IVIG) and prescribed aspirin at 1,200 mg/ day beginning on the day 17 after onset.…”

Section: Case Reportmentioning

confidence: 99%

Adult Kawasaki Disease Unrelated to Epstein-Barr Virus and Group A Streptococcus

et al. 2005

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A 23-year-old Japanese woman with a fever and generalized skin eruptions was referred to our hospital in July 1999. At admission, her temperature was 38.9°C, and she had fluctuating symptoms including erythema of the extremities, conjunctival hyperemia, strawberry tongue, and generalized skin eruptions, but lymphadenopathy was not verified. An initially elevated urine leukocyte count (more than 100 per high power field) later returned to normal range without antibiotic therapy. Adult Kawasaki disease was diagnosed on the basis of the above symptomology. Echocardiograph showed transient effusion in the pericardium. Using the Harada scoring system for treatment of Kawasaki disease, we gave the patient aspirin and did not administer intravenous immunoglobulin. The clinical course was uneventful, and on the day of discharge (day 22 after onset), the laboratory test results were nearly normal. Laboratory test results were negative for both Epstein-Barr virus and group A Streptococcus.

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“…24) Administration of IVIG reduced the prevalence of CAA in Japan from 15-25% in children treated with aspirin alone 25,26) to 4-12% in those who were treated with IVIG and aspirin. [27][28][29] We have been using the same combination of IVIG and aspirin with good results.…”

Section: Discussionmentioning

confidence: 99%

<b>Kawasaki Disease</b>

et al. 2005

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SUMMARYKawasaki disease (KD) has not been frequently reported from developing countries, especially from India. In this series from a tertiary level center in North India, we report on the clinical features and management of patients with KD seen between January 1994 to November 2004. KD was diagnosed on the basis of standard diagnostic criteria. Investigations included work-up for other causes of fever along with chest X-rays, electrocardiograms, and 2-D echocardiography. Thallium scintigraphy and coronary angiography were performed in 20 and 3 cases, respectively. Sixty-nine children (49 boys and 20 girls) fulfilled the diagnostic criteria. Mean age at diagnosis was 4.9 ± 3.0 years (range 0.3-14 years) and as many as 23 cases (33.3%) were above 5 years of age. Clustering was seen during the winter months. Extreme irritability, out of proportion to the degree of fever, was a characteristic feature. Redness of the lips and tongue was common but rash was seen only in 43 cases and lymphadenopathy in 47 cases. Thrombocytosis was present in 52.2% of the patients. Sixty-four patients received intravenous immunoglobulin. Cardiac abnormalities included extrasystoles in 1, coronary artery dilatation in 5, valvular regurgitation in 3, and perfusion defects on thallium scintigraphy in 4. There was no mortality. KD appears to occur at an older age in Indian children as compared to reports from Japan. Irritability is a characteristic clinical finding. Cardiac abnormalities are frequent during the acute stage but regress gradually. The disease needs to be considered in the differential diagnosis of all children with persistent unexplained fever. (Int Heart J 2005; 46: 679-689)

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Intravenous γ‐Globulin Treatment in Kawasaki Disease

Cited by 230 publications

References 1 publication

Plasminogen Activator Inhibitor-1 in Patients with Kawasaki Disease: Diagnostic Value for the Prediction of Coronary Artery Lesion and Implication for a New Mode of Therapy

Plasminogen Activator Inhibitor-1 in Patients with Kawasaki Disease: Diagnostic Value for the Prediction of Coronary Artery Lesion and Implication for a New Mode of Therapy

Adult Kawasaki Disease Unrelated to Epstein-Barr Virus and Group A Streptococcus

<b>Kawasaki Disease</b>

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