从招募红细胞的上皮-间质转化角度看川崎病的临床体征:文献综述

Clinical Signs of Kawasaki Disease from the Perspective of Epithelial-to-Mesenchymal Transition Recruiting Erythrocytes: A Literature Review.

作者信息

Oh Jin-Hee, Cho Soyun, Choi Jin A

机构信息

Department of Pediatrics, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, 16247 Seoul, Republic of Korea.

Department of Dermatology, Boramae Medical Center, College of Medicine, Seoul National University, 07061 Seoul, Republic of Korea.

出版信息

Rev Cardiovasc Med. 2023 Apr 17;24(4):109. doi: 10.31083/j.rcm2404109. eCollection 2023 Apr.

Abstract

Kawasaki disease (KD) is a systemic vasculitis affecting children younger than 5 years of age. Early period in life is marked by rapid somatic growth with cell proliferation and immaturity of the immunity with dominant innate immune system. Coronary complications in KD are the most common acquired heart disease in children, yet the diagnosis of KD still depends on the clinical diagnostic criteria. Glossy red lips and conjunctival injection are characteristic signs enabling pediatricians to make the initial diagnosis of KD; however, little is known why these are so characteristic. The diagnostic criteria of KD seem to be scattered in seemingly irrelevant body systems such as the eyes, lips, skin, and heart. KD is classified as a connective tissue disease. Recently, red blood cells (RBCs) have emerged as important modulators in innate immune response. RBCs are reported to participate in extracellular matrix remodeling and upregulating matrix metalloproteinase (MMP) expression in dermal fibroblasts. Also, fibroblast growth factors and microRNAs associated with fibrosis are drawing attention in KD. The cardinal signs of KD appear at the border of muco-cutaneous junction. Head and neck regions are abundant in tissues undergoing epithelial-to-mesenchymal transition (EMT). Interstitial carditis and valve insufficiency as well as coronary arterial lesions may complicate KD, and these lesions present in tissues that originated from epicardial progenitor cells by EMT. Having reviewed the recent research on KD, we presume that the signs of KD present at borders between keratinized and non-keratinized stratified squamous epithelium where the EMT is still ongoing for the rapid somatic growth where RBCs are recruited as an innate immune response and to prevent excessive fibrosis in mucosa. KD presents scarcely in adults with somatic growth and immune maturation completed. In this review, we attempted to explain the reasons for the clinical manifestations of KD and to search for a link among the diagnostic clues in the perspective of EMT during the somatic growth and immune system maturation in children with KD.

摘要

川崎病(KD)是一种影响5岁以下儿童的全身性血管炎。生命早期的特点是身体快速生长,细胞增殖,免疫系统不成熟,先天免疫系统占主导。KD中的冠状动脉并发症是儿童最常见的后天性心脏病,然而KD的诊断仍依赖于临床诊断标准。嘴唇鲜红和结膜充血是使儿科医生能够初步诊断KD的特征性体征;然而,对于为什么这些体征如此具有特征性却知之甚少。KD的诊断标准似乎分散在看似不相关的身体系统,如眼睛、嘴唇、皮肤和心脏。KD被归类为结缔组织疾病。最近,红细胞(RBCs)已成为先天免疫反应中的重要调节因子。据报道,RBCs参与细胞外基质重塑并上调真皮成纤维细胞中基质金属蛋白酶(MMP)的表达。此外,与纤维化相关的成纤维细胞生长因子和微小RNA在KD中也受到关注。KD的主要体征出现在黏膜皮肤交界处。头颈部区域富含经历上皮-间充质转化(EMT)的组织。间质性心肌炎、瓣膜功能不全以及冠状动脉病变可能使KD复杂化,而这些病变出现在通过EMT起源于心外膜祖细胞的组织中。在回顾了关于KD的最新研究后,我们推测KD的体征出现在角化和非角化复层鳞状上皮之间的边界处,在那里EMT仍在进行,以实现快速的身体生长,RBCs作为先天免疫反应被募集,以防止黏膜过度纤维化。KD在身体生长和免疫成熟完成的成年人中几乎不出现。在本综述中,我们试图从KD患儿身体生长和免疫系统成熟过程中的EMT角度解释KD临床表现的原因,并寻找诊断线索之间的联系。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94fd/11273048/3bfaf7667b8d/2153-8174-24-4-109-g1.jpg

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