Soluble forms of P-, E- and L-selectin in children with Kawasaki disease.

Kawasaki disease (KD) is an acute, self-limiting systemic vasculitis syndrome of unknown origin, that mainly affects small and medium-sized arteries, particularly the coronary artery, which affects primarily infants and young children. Cell adhesion molecules play important roles in the inflammatory process. The aims of this study were to investigate the pathophysiological role of cell adhesion molecules in KD, and to look for the evidence of direct relationship between the plasma levels of soluble cell adhesion molecules and the incidence of coronary artery lesion (CAL). The 52 patients with KD, Group A patients who were clinical responders of initial intravenous immunoglobulin (IVIG) treatment (n = 30), Group B patients who did not respond to the initial IVIG treatment (n = 22), were studied. The circulating E-selectin (105.6 +/- 12.6 ng/ml) in the acute phase of KD, while the peak plasma P-selectin level (238.4 +/- 26.8 ng/ml) occurred in the subacute phase of illness (p < 0.05, respectively). Plasma L-selectin levels (1557.3 +/- 44.3 ng/ml) during the convalescent phase tend to higher than in the acute and in the convalescent phases (p = NS). The analysis of paired samples in Group A patients before (E-selectin: 131.2 +/- 9.8 ng/ml, P-selectin: 216.6 +/- 13.4 ng/ml) and 48 hour after (E-selectin: 98.9 +/- 9.2 ng/ml, P-selectin: 153.9 +/- 34.1 ng/ml) IVIG administration revealed significantly lower values of E- and P-selectins, however, no significant differences in those in Group B patients. There were also no significant differences in the values of L-selectins between the 2 groups. Before IVIG treatment, the plasma levels of E- (225.1 +/- 46.1 ng/ml) and P-selectin (259.4 +/- 76.2 ng/ml) of patients with CAL (n = 11) were significantly higher than those of patients (n = 41) without CAL (p < 0.05, respectively). Plasma L-selectin levels (1596.9 +/- 385.0 ng/ml) in patients with CAL tended to be lower than those in patients without CAL (p = NS). E- and P-selectin may have potential as predictors of CAL in patients with KD.