Korean J Pediatr.  2017 Jul;60(7):208-215. 10.3345/kjp.2017.60.7.208.

Association of Toll-like receptor 2-positive monocytes with coronary artery lesions and treatment nonresponse in Kawasaki disease

• Kang SJ
• Kim NS

• KMID: 2387769
• DOI: http://doi.org/10.3345/kjp.2017.60.7.208

Abstract

PURPOSE
Activation of Toll-like receptor 2 (TLR2) present on circulating monocytes in patients with Kawasaki disease (KD) can lead to the production of proinflammatory cytokines and interleukin-10 (IL-10). We aimed to determine the association of the frequency of circulating TLR2+/CD14+ monocytes (FTLR2%) with the outcomes of KD, as well as to compare FTLR2% to the usefulness of sIL-10.
METHODS
The FTLR2% in patients with KD was measured by flow cytometry. Serum levels of IL-10 (sIL-10) were determined in 31 patients with KD before the initial treatment with intravenous immunoglobulin (IVIG) and in 21 febrile controls by using enzyme-linked immunosorbent assay. Patients were classified as having coronary artery lesions (CALs) based on the maximal internal diameters of the proximal right coronary artery and proximal left anterior descending coronary artery one month after the initial diagnosis.
RESULTS
We found that FTLR2% greater than 92.62% predicted CALs with 80% sensitivity and 68.4% specificity, whereas FTLR2% more than 94.61% predicted IVIG resistance with 66.7% sensitivity and 71.4% specificity. Moreover, sIL-10 more than 15.52 pg/mL predicted CALs and IVIG resistance with 40% and 66.7% sensitivity, respectively, and 73.7% and 76.2% specificity, respectively.
CONCLUSION
We showed that measuring FTLR2% before the initial treatment could be useful in predicting CAL development with better sensitivity than sIL-10 and with results comparable to sIL-10 results for the prediction of IVIG resistance in patients with KD. However, further studies are necessary to validate FTLR2% as a marker of prognosis and severity of KD.

Keyword

Kawasaki disease; Immunoglobulins; Coronary arteries; Toll-like receptors; Interleukins

MeSH Terms

Coronary Vessels*
Cytokines
Diagnosis
Enzyme-Linked Immunosorbent Assay
Flow Cytometry
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Interleukin-10
Interleukins
Monocytes*
Mucocutaneous Lymph Node Syndrome*
Prognosis
Sensitivity and Specificity
Toll-Like Receptor 2
Toll-Like Receptors*
Cytokines
Immunoglobulins
Immunoglobulins, Intravenous
Interleukin-10
Interleukins
Toll-Like Receptor 2
Toll-Like Receptors