White Blood Cell and Neutrophil Counts and Response to Intravenous Immunoglobulin in Kawasaki Disease

Muto, Taichiro; Masuda, Yu; Numoto, Shingo; Kodama, Shunsuke; Yamakawa, Kiyoshi; Takasu, Michihiko; Hayakawa, Tomohito; Miyata, Kenji; Miyamoto, Ryosuke; Akaihata, Mitsuko; Iwayama, Hideyuki; Kitagawa, Yoshiro; Kurahashi, Hirokazu; Shimomura, Yasuto; Hori, Toshinori; Okuda, Masumi; Agata, Hiroatsu; Okumura, Akihisa

doi:10.1177/2333794x19884826

Cited by 12 publications

(10 citation statements)

References 30 publications

(42 reference statements)

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“…Previous studies have suggested elevated neutrophil counts in IVIG resistance ( 17 , 18 , 71 ). However, we and others ( 72 , 73 ) did not observe elevated neutrophil counts in either IVIG-resistant patients or IVIG-resistant patients with CAL as compared to those in IVIG-responsive patients. Perhaps our small and heterogeneous patient population may account for these differences in the neutrophil counts.…”

Section: Discussioncontrasting

confidence: 76%

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

et al. 2020

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Kawasaki disease (KD) is the leading cause of acquired pediatric heart disease in the developed world as 25–30% of untreated patients and at least 5% of treated patients will develop irreversible coronary artery lesions (CAL). Pentraxin-3 (PTX-3) has been well-studied in inflammatory diseases, particularly in cardiovascular diseases associated with vascular endothelial dysfunction. We hypothesized that PTX-3 plays an important role in the development of KD-associated CAL and investigated the circulating levels of PTX-3 in the serum of KD patients. Children with acute KD were followed from diagnosis through normalization of the clinical parameters of inflammation (convalescent phase). Serum samples were obtained and echocardiograms were conducted at several phases of the illness: acute [prior to intravenous immunoglobulin (IVIG) treatment], sub-acute (5–10 days after IVIG treatment), and convalescent (1–4 months after KD diagnosis). Seventy children were included in the final cohort of the study, of whom 26 (37%) presented with CAL and 18 (26%) developed IVIG resistance. The patients included in this study came from diverse ethnic backgrounds, mostly with mixed ancestry/ ethnicity. Significantly increased PTX-3 levels were observed during the acute phase of KD compared to the sub-acute and the convalescent phases. The PTX-3 levels during acute KD were significantly higher among KD patients with CAL compared to patients with normal coronary arteries (NCA). Also, the PTX-3 levels were significantly higher in patients with IVIG resistance. Furthermore, the PTX-3 levels were significantly higher in IVIG-resistant KD patients with CAL as compared to the NCA group. Moreover, the PTX-3 levels were significantly correlated to coronary artery z-score during acute KD and to neutrophil counts throughout KD progression regardless of coronary artery z-score. Elevated PTX-3 levels correlated to elevated neutrophil counts, a known source of PTX-3 in acute inflammation and an important player in the development of KD vasculitis. We, therefore, suggest PTX-3 as a novel factor in the development of KD-associated CAL and propose neutrophil-derived PTX-3 as contributing to KD vascular dysfunction.

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Section: Discussioncontrasting

confidence: 76%

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

et al. 2020

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“…Similar to adults with COVID-19, neutrophilia and lymphocytopenia are common in MIS-C. Neutrophils play a key functional role in Kawasaki disease with recent descriptions of NETosis and neutrophil activation in the form of CD11b and CD64 production ( 91 ). Neutrophil counts predict responsiveness of patients with Kawasaki disease to intravenous immunoglobulin therapy, also used in MIS-C ( 92 , 93 ). Neutrophils activation marker Fc γ receptor I (FcγRI; CD64) was described to be highly expressed on neutrophils of treatment-naive MIS-C patients in acute phase compared with healthy controls ( 94 ).…”

Section: Neutrophils and Covid-19 In Childrenmentioning

confidence: 99%

Neutrophils in COVID-19: Not Innocent Bystanders

et al. 2022

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Unusually for a viral infection, the immunological phenotype of severe COVID-19 is characterised by a depleted lymphocyte and elevated neutrophil count, with the neutrophil-to-lymphocyte ratio correlating with disease severity. Neutrophils are the most abundant immune cell in the bloodstream and comprise different subpopulations with pleiotropic actions that are vital for host immunity. Unique neutrophil subpopulations vary in their capacity to mount antimicrobial responses, including NETosis (the generation of neutrophil extracellular traps), degranulation and de novo production of cytokines and chemokines. These processes play a role in antiviral immunity, but may also contribute to the local and systemic tissue damage seen in acute SARS-CoV-2 infection. Neutrophils also contribute to complications of COVID-19 such as thrombosis, acute respiratory distress syndrome and multisystem inflammatory disease in children. In this Progress review, we discuss the anti-viral and pathological roles of neutrophils in SARS-CoV-2 infection, and potential therapeutic strategies for COVID-19 that target neutrophil-mediated inflammatory responses.

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“…On the other hand, for predicting initial IVIG responsiveness, there have been reports on the utility of white blood cell count, hemoglobin, CRP, albumin, and d-dimer (32)(33)(34). However, we failed to predict the responsiveness of additional IVIG by those conventional markers as shown in Table 2.…”

Section: Discussionmentioning

confidence: 63%

Utility of Soluble CD163 in the Clinical Management of Patients With Kawasaki Disease

et al. 2020

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Objective: Intravenous immunoglobulin (IVIG) therapy is a useful first-line treatment for Kawasaki disease (KD); however, 10-20% of patients fail to respond and require additional IVIG. Soluble CD163 (sCD163) is considered a biomarker for macrophage activation. There are no reports measuring serum sCD163 in KD patients. This study aimed to explore its possible utility in the clinical management of patients with KD. Methods: Eighty-seven patients with well-defined KD were retrospectively enrolled together with 19 healthy individuals with comparable ages. KD patients were classified into three groups, Group A (initial IVIG responders), Group B (additional IVIG responders), and Group C (additional IVIG non-responders). Serum sCD163 together with complete blood counts, C-reactive protein, d-dimer, albumin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were measured before the initial IVIG treatment in all cases, and afterward in a fraction of cases. Results: Serum sCD163 in KD patients before initial IVIG was generally much higher than the control group. The median (interquartile range) of sCD163 was as follows: Control 446 (385-521) ng/mL; Group A, 699 (478-1,072); Group B, 1,349 (1,116-1,390); and Group C, 665 (544-1,094). In general, sCD163 showed close positive correlation with ALT and AST, but none with other markers. Among the KD groups, Group B showed the highest sCD163: Group B vs. A: p = 0.0003; B vs. C: p = 0.035). Serum sCD163 was significantly increased after IVIG in Group A, while no change occurred in others. Conclusion: The serum sCD163 levels could be a useful biomarker in the clinical management of KD, especially for predicting responsiveness to IVIG.

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White Blood Cell and Neutrophil Counts and Response to Intravenous Immunoglobulin in Kawasaki Disease

Cited by 12 publications

References 30 publications

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease

Neutrophils in COVID-19: Not Innocent Bystanders

Utility of Soluble CD163 in the Clinical Management of Patients With Kawasaki Disease

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