Korean J Pediatr.  2006 Dec;49(12):1348-1353. 10.3345/kjp.2006.49.12.1348.

The effects of high-dose intravenous immunoglobulin on plasma protein and lipid levels in the patients with Kawasaki disease

• Lee KY
• Kim DU
• Lee HS
• Jang PS
• Kim YH
• Kim JT
• Kim HH
• Lee KY
• Lee JS

• KMID: 2278509
• DOI: http://doi.org/10.3345/kjp.2006.49.12.1348

Abstract

PURPOSE: The reticuloendothelial system is composed of sinusoidal capillaries, through which even large protein molecules are freely movable between plasma and interstitial space, including the lymphatic system. Therefore, high-dose intravenous immunoglobulin (IVIG) would cause a redistribution of proteins between two compartments. To investigate this hypothesis, we measured plasma protein and lipid levels in patients with Kawasaki disease before and after high-dose IVIG treatment.
METHODS
Thirty four children with Kawasaki disease who had complete responses to high-dose IVIG treatment (1 g/kg/day for two consecutive days), were analyzed. Before and after the administration of IVIG, serum analyses were performed for such parameters as total protein, albumin, gamma-globulins (IgG, IgM, IgA), alpha1-, alpha2-, and beta-globulin fractions, and lipid profiles (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride).
RESULTS
The levels of gamma-globulins including IgG, IgM, IgA were significantly increased, and IgG was increased by 1,779+/-304 mg/dL after two-dose of IVIG infusion. The levels of albumin, alpha1-, alpha2-, and beta-globulin fractions were significantly decreased by 18 percent, 24 percent, 19 percent and 12 percent, respectively. HDL-cholesterol level was significantly decreased by 20 percent, while LDL-cholesterol and triglyceride levels were significantly increased by 21 percent and 50 percent, respectively. The total cholesterol level was not changed.
CONCLUSION
High-dose IVIG treatment decreased the levels of a variety of proteins except immunoglobulins, and the increase of IgG after IVIG treatment was lower than expected. Our results suggest that a part of infused IVIG and plasma proteins, including etiologic proteins for Kawasaki disease, may be distributed to the extravascular compartments. The rapid improvement of symptoms induced by IVIG in Kawasaki disease might be explained by this mode of action of IVIG.

Keyword

Intravenous immunoglobulin; Mucocutaneous lymph node syndrome; Plasma protein; Plasma lipid

MeSH Terms

Beta-Globulins
Blood Proteins
Capillaries
Child
Cholesterol
gamma-Globulins
Humans
Immunoglobulin A
Immunoglobulin G
Immunoglobulin M
Immunoglobulins*
Immunoglobulins, Intravenous
Lymphatic System
Mononuclear Phagocyte System
Mucocutaneous Lymph Node Syndrome*
Plasma*
Triglycerides
Beta-Globulins
Blood Proteins
Cholesterol
Immunoglobulin A
Immunoglobulin G
Immunoglobulin M
Immunoglobulins
Immunoglobulins, Intravenous
gamma-Globulins