Serum Nitric Oxide and Tumor Necrosis Factor-alpha Levels in Patients with Kawasaki Disease

Park, Ji Hye; Shin, Jee Seon; Hong, Young Mi

Abstract

PURPOSE
Kawasaki disease (KD) is a systemic panvasculitis that causes coronary artery lesions. KD is accompanied by immunoregulatory abnormalities. Nitric oxide (NO) can induce relaxation of blood vessels by activating guanylate cyclase in smooth muscle cells and high levels of NO may result in coronary artery lesions. We investigated tumor necrosis factor (TNF)-alpha and NO production before and after intravenous immunoglobulin (IVIG) therapy to study the roles of NO and TNF-alpha in KD with coronary artery lesions. METHODS: Serum levels of NO and TNF-alpha were measured in 24 patients with KD (group I, eight patients with normal coronary artery; group II, 16 patients with coronary artery lesions) and 23 controls (group III, 13 afebrile controls; group IV, 10 febrile controls). Blood samples from each subject were drawn before and after IVIG therapy and in the convalescent stage. Serum concentrations of NO and TNF-alpha were measured by enzyme linked immuno sorbent assay. RESULTS: The NO levels before IVIG therapy were significantly higher in group II than in group I, group III and group IV. After IVIG therapy the levels of NO were significantly higher in group I and group II than in group III. The TNF-alpha levels before IVIG therapy were significantly higher in group I and group II than in group III. The serum TNF-alpha and NO levels were higher before IVIG therapy and decreased through the convalescent stage in KD patients. In the acute stage of KD patients with coronary artery lesions, serum NO levels significantly correlated with white blood cells (r=043, P< 0.05). CONCLUSION: The serum concentration levels of TNF-alpha and NO were abnormally high in KD patients and NO concentrations were statistically higher in the KD patients with coronary artery abnormalities than those without coronary abnormality during the early stage of the KD. These results suggest NO may be involved in the development of coronary artery lesions.