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Han: Could Immunoglobulin Level Be a Prognostic Factor for Coronary Artery Lesions in Kawasaki Diseases?
Editorial

Korean Circulation Journal 2021; 51(3): 279-280.

Published online: 19 February 2021

DOI: https://doi.org/10.4070/kcj.2021.0046

Could Immunoglobulin Level Be a Prognostic Factor for Coronary Artery Lesions in Kawasaki Diseases?

Mi Young Han, MD, PhD

Department of Pediatrics, Kyung Hee University Hospital, Seoul, Korea.

Correspondence to Mi Young Han, MD, PhD. Department of Pediatrics, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea. myhan44@naver.com.

Received 7 February 2021       Accepted 15 February 2021

Copyright © 2021. The Korean Society of Cardiology

The Korean Society of Cardiology

(open-access, https://creativecommons.org/licenses/by-nc/4.0):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Although etiology of Kawasaki disease (KD) remains unknown, both epidemiologic and clinical characteristics strongly support an infectious etiology. So, most accepted hypothesis of KD pathogenesis is systemic vasculitis due to host immune responses resulting from ubiquitous agents causing infection in genetically predisposed children.1) Studies supporting this hypothesis by Rowley et al.2)3) showed that CD8+ T cells, oligoclonal immunoglobulin (Ig) A, and upregulation of cytotoxic T cell and interferon pathway genes were observed in the coronary arteries in fatal KD patients. In addition, a study using a murine model with KD vasculitis by Noval Rivas et al.4) also proved that intestinal barrier dysfunction causes secretory IgA leakage, IgA-C3 immune complex is deposited in the vascular tissue, and increased IgA production is a key role in vasculitis.
Without intravenous immunoglobulin (IVIG) use, Ig (IgG, IgA, IgM) has been reported to increase during 1 to 2 weeks of KD administration and then decrease to normal levels within 4 weeks.5) In particular, Ohshio et al.6) reported increased secretory IgA and serum total IgA, and Gupta et al.7) also reported an increase in IgA anticardiolipin antibodies in KD patients, suggesting that the degree of increase in these immune antibodies reflects the degree of systemic inflammation. Based on these results, it is thought that serum Ig levels may be related to the occurrence of coronary complications, and thus may be used as a useful therapeutic index.
In this issue of Korean Circulation Journal, Kim et al.8) reported results regarding the comparison between serum Ig levels (IgG, IgA, IgM, and IgE) during clinical courses and coronary artery lesions (CALs) in KD. They conducted a study using blood samples and clinical data from 241 KD patients collected from 11 hospitals. Through this study, they showed significantly higher Ig levels (IgG, IgA, IgM, and IgE) in the subacute phase compared to the reference Ig values. In particular, the IgA level of the CALs group was 2.2 times higher in the acute phase and 1.7 times higher in the subacute phase than those in the non-CAL group, and IgA levels sowed a strong correlation with CAL size. So, they suggested high IgA levels in patients with KD may have an increased risk of CALs. These results support the research findings that IgA plays an important key role in KD pathogenesis.4)
However, these results are inconsistent with the results of previous studies. Yanagimoto et al.9) reported that there was no significant differences between pretreatment levels for IgG, IgA or IgM in patients with or without CALs, but IVIG non-responders had significantly higher pretreatment IgG values. The results of Sawaji et al.10) also suggested that the high IgG level before IVIG treatment was a risk factor for CAL, but IgA level was rather lower in the CAL group. Therefore, it is not yet possible to conclude that a specific Ig level is a definite predictor of clinical outcomes.
This study has some limitations. First, in the study subjects, Ig levels were not measured serially at each clinical stage of KD. Because the number of CAL patients was very small in the acute phase, it was not appropriate to accurately analyze the correlation between pretreatment Ig levels and clinical outcome. More detailed examinations during the all clinical phases of KD have the potential to refine these relationships. Another limitation is that they have no age-matched healthy control, because it is known that Ig levels increases with age except for the newborn period.
Therefore, to determine the usefulness of the Ig levels during the clinical course of KD in predicting the clinical outcomes, more studies are needed on the relationship of Ig levels and clinical outcomes.

Notes

Funding: The author received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest: The author has no financial conflicts of interest.

Data Sharing Statement: The data generated in this study is available from the corresponding author upon reasonable request.

The contents of the report are the author's own views and do not necessarily reflect the views of the Korean Circulation Journal.

References

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