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      Advances in understanding Kawasaki disease‐related immuno‐inflammatory response and vascular endothelial dysfunction

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          ABSTRACT

          Kawasaki disease (KD) is a systemic vasculitis of unknown etiology, which tends to involve coronary arteries and can lead to acquired heart disease in children. The immuno‐inflammatory response and vascular endothelial dysfunction are important causes of coronary artery disease in patients with KD. Multisystem inflammatory syndrome in children (MIS‐C) is a rare inflammatory disease in children identified in recent years, which is caused by severe acute respiratory syndrome coronavirus 2 infection; this disease overlaps with KD. This review examines research progress concerning the immuno‐inflammatory response and vascular endothelial dysfunction associated with KD, as well as differences between KD and MIS‐C.

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          Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis

          I Hamming, W Timens, MLC Bulthuis … (2004)
          Abstract Severe acute respiratory syndrome (SARS) is an acute infectious disease that spreads mainly via the respiratory route. A distinct coronavirus (SARS‐CoV) has been identified as the aetiological agent of SARS. Recently, a metallopeptidase named angiotensin‐converting enzyme 2 (ACE2) has been identified as the functional receptor for SARS‐CoV. Although ACE2 mRNA is known to be present in virtually all organs, its protein expression is largely unknown. Since identifying the possible route of infection has major implications for understanding the pathogenesis and future treatment strategies for SARS, the present study investigated the localization of ACE2 protein in various human organs (oral and nasal mucosa, nasopharynx, lung, stomach, small intestine, colon, skin, lymph nodes, thymus, bone marrow, spleen, liver, kidney, and brain). The most remarkable finding was the surface expression of ACE2 protein on lung alveolar epithelial cells and enterocytes of the small intestine. Furthermore, ACE2 was present in arterial and venous endothelial cells and arterial smooth muscle cells in all organs studied. In conclusion, ACE2 is abundantly present in humans in the epithelia of the lung and small intestine, which might provide possible routes of entry for the SARS‐CoV. This epithelial expression, together with the presence of ACE2 in vascular endothelium, also provides a first step in understanding the pathogenesis of the main SARS disease manifestations. Copyright © 2004 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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            An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study

            Lucio Verdoni, Angelo Mazza, Annalisa Gervasoni … (2020)
            Summary Background The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic. Methods All patients diagnosed with a Kawasaki-like disease at our centre in the past 5 years were divided according to symptomatic presentation before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. Kawasaki- like presentations were managed as Kawasaki disease according to the American Heart Association indications. Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction, and macrophage activation syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation criteria. Current or previous infection was sought by reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively. Findings Group 1 comprised 19 patients (seven boys, 12 girls; aged 3·0 years [SD 2·5]) diagnosed between Jan 1, 2015, and Feb 17, 2020. Group 2 included ten patients (seven boys, three girls; aged 7·5 years [SD 3·5]) diagnosed between Feb 18 and April 20, 2020; eight of ten were positive for IgG or IgM, or both. The two groups differed in disease incidence (group 1 vs group 2, 0·3 vs ten per month), mean age (3·0 vs 7·5 years), cardiac involvement (two of 19 vs six of ten), KDSS (zero of 19 vs five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid treatment (three of 19 vs eight of ten; all p<0·01). Interpretation In the past month we found a 30-fold increased incidence of Kawasaki-like disease. Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic. Funding None.
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              Tolerance, danger, and the extended family.

              P Matzinger (1994)
              For many years immunologists have been well served by the viewpoint that the immune system's primary goal is to discriminate between self and non-self. I believe that it is time to change viewpoints and, in this essay, I discuss the possibility that the immune system does not care about self and non-self, that its primary driving force is the need to detect and protect against danger, and that it does not do the job alone, but receives positive and negative communications from an extended network of other bodily tissues.
              Article 0 comments Cited 313 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tao Li: 15907281818@163.com
                Journal
                Journal ID (nlm-ta): Pediatr Investig
                Journal ID (iso-abbrev): Pediatr Investig
                Journal ID (doi): 10.1002/(ISSN)2574-2272
                Journal ID (publisher-id): PED4
                Title: Pediatric Investigation
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 2096-3726
                ISSN (Electronic): 2574-2272
                Publication date (Electronic): 01 August 2022
                Publication date Collection: December 2022
                Volume: 6
                Issue: 4 , Cardiovascular Disease ( doiID: 10.1002/ped4.v6.4 )
                Pages: 271-279
                Affiliations
                [ 1 ] Department of Pediatrics, Affiliated Taihe Hospital of Hubei University of Medicine Shiyan Hubei China
                Author notes
                [*] [* ] Correspondence

                Tao Li, Department of Pediatrics, Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan 442000, Hubei, China.

                Email: 15907281818@ 123456163.com

                Author information
                https://orcid.org/0000-0001-6807-9315
                Article
                Publisher ID: PED412341
                DOI: 10.1002/ped4.12341
                PMC ID: 9789937
                PubMed ID: 36582276
                SO-VID: 8ccc86dd-4afd-4fe8-ac4a-b7e939883415
                Copyright © © 2022 Chinese Medical Association. Pediatric Investigation published by John Wiley & Sons Australia, Ltd on behalf of Futang Research Center of Pediatric Development.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 16 March 2022
                Date accepted : 23 June 2022
                Page count
                Figures: 3, Tables: 0, Pages: 9, Words: 5500
                Categories
                Subject: Review
                Subject: Review
                Custom metadata
                source-schema-version-number 2.0
                cover-date December 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.3 mode:remove_FC converted:24.12.2022

                Keywords: kawasaki disease,inflammation,endothelial cells,multisystem inflammatory syndrome in children
                Data availability:
                Keywords: kawasaki disease, inflammation, endothelial cells, multisystem inflammatory syndrome in children

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