Circulating Markers of Inflammation Persist in Children and Adults With Giant Aneurysms After Kawasaki Disease

Author:

Lech Miroslaw1,Guess Jamey1,Duffner Jay1,Oyamada Jun2,Shimizu Chisato2,Hoshino Shinsuke2,Farutin Victor1,Bulik Dorota A.1,Gutierrez Bryan1,Sarvaiya Hetal1,Kapoor Bulbul1,Koppes Laura1,Saldova Radka3,Stockmann Henning3,Albrecht Simone3,McManus Ciara3,Rudd Pauline M.3,Kaundinya Ganesh V.1,Manning Anthony M.1,Bosques Carlos J.1,Kahn Andrew M.2,Daniels Lori B.2,Gordon John B.4,Tremoulet Adriana H.25,Capila Ishan1,Gunay Nur Sibel1,Ling Leona E.1,Burns Jane C.25

Affiliation:

1. Momenta Pharmaceuticals, Inc, Cambridge, MA (M.L., J.G., J.D., V.F., D.A.B., B.G., H.S., B.K., L.K., G.V.K., A.M.M., C.J.B., I.C., N.S.G., L.E.L.).

2. University of California San Diego School of Medicine (J.O., C.S., S.H., A.M.K., L.B.D., A.H.T., J.C.B.).

3. National Institute for Bioprocessing Research and Training GlycoScience Group, Dublin, Ireland (R.S., H.S., S.A., C.M., P.M.R.).

4. San Diego Cardiac Center, CA (J.B.G.).

5. Rady Children’s Hospital–San Diego (A.H.T., J.C.B.).

Abstract

Background: The sequelae of Kawasaki disease (KD) vary widely with the greatest risk for future cardiovascular events among those who develop giant coronary artery aneurysms (CAA). We sought to define the molecular signature associated with different outcomes in pediatric and adult KD patients. Methods: Molecular profiling was conducted using mass spectrometry–based shotgun proteomics, transcriptomics, and glycomics methods on 8 pediatric KD patients at the acute, subacute, and convalescent time points. Shotgun proteomics was performed on 9 KD adults with giant CAA and matched healthy controls. Plasma calprotectin was measured by ELISA in 28 pediatric KD patients 1 year post-KD, 70 adult KD patients, and 86 healthy adult volunteers. Results: A characteristic molecular profile was seen in pediatric patients during the acute disease, which resolved at the subacute and convalescent periods in patients with no coronary artery sequelae but persisted in 2 patients who developed giant CAA. We, therefore, investigated persistence of inflammation in KD adults with giant CAA by shotgun proteomics that revealed a signature of active inflammation, immune regulation, and cell trafficking. Correlating results obtained using shotgun proteomics in the pediatric and adult KD cohorts identified elevated calprotectin levels in the plasma of patients with CAA. Investigation of expanded pediatric and adult KD cohorts revealed elevated levels of calprotectin in pediatric patients with giant CAA 1 year post-KD and in adult KD patients who developed giant CAA in childhood. Conclusions: Complex patterns of biomarkers of inflammation and cell trafficking can persist long after the acute phase of KD in patients with giant CAA. Elevated levels of plasma calprotectin months to decades after acute KD and infiltration of cells expressing S100A8 and A9 in vascular tissues suggest ongoing, subclinical inflammation. Calprotectin may serve as a biomarker to inform the management of KD patients following the acute illness.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine

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