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Immunologic Alterations of Peripheral Mononuclear Cells by Intravenous Immunoglobulin in the Acute Stage of Kawasaki disease

Journal of the Korean Pediatric Society 1998;41(6):813-824.
Published online June 15, 1998.
Immunologic Alterations of Peripheral Mononuclear Cells by Intravenous Immunoglobulin in the Acute Stage of Kawasaki disease
Ji-Whan Han, Kyung-Yil Lee, Kyong-Su Lee
Department of Pediatrics, Catholic University College of Medicine, Seoul, Korea
가와사끼병의 급성기에 투여한 정맥용 면역글로불린이 말초혈액 단핵세포에 미치는 면역학적 변화
한지환, 이경일, 이경수
가톨릭대학교 의과대학 소아과학교실
Correspondence: 
Ji-Whan Han, Email: 1
Abstract
Purpose
: High dose intravenous immunoglobulin(IVIG) therapy is effective in reducing the incidence of coronary artery aneurysm in Kawasaki disease(KD) patients, however, the precise mechanisms by which IVIG reverses the immune activation is unknown.
Methods
: The sera and peripheral mononuclear cells(PBMCs) were obtained from 10 KD patients in the acute stage(24 hrs before) and 24 hrs after one dose of IVIG(2g/kg) treatment. We measured serum interleukin 6(IL-6) and tumor necrosis factor α(TNF-α) and compared them to the messenger RNA expression of the PBMCs by reverse transcription polymerase chain reaction. We also investigated the cytokines’ or immunoglobulins’ production of PBMCs which were stimulated with phytohemagglutinin-P(PHA-P) or pokeweed mitogen(PWM, without in vitro IVIG treatment) by enzyme-linked immunosorbent assay.
Results
: The serum levels of IL-6 and TNF-α decreased significantly after IVIG treatment. However, the gene expression of IL-6 and TNF-α showed no significant difference after IVIG treatment. IL-6 and TNF-α productions of PBMCs stimulated with PHA-P decreased significantly after IVIG treatment, however, IL-4 and IFN-γ production showed no significant differences. IL-6 production of PBMCs stimulated with PWM also decreased significantly after IVIG treatment, but TNF-α did not change significantly. The synthesis of IgG, IgM, IgA and IgG1 after IVIG treatment showed a significant decrease, and that of IgG2 showed a slight decrease, but was not statistically significant.
Conclusion
: The results demonstrate that the administration of IVIG in the acute stage of KD resulted in the alterations of activated immunologic abnormalities, especially in monocytes and B cells.
Key Words: Kawasaki disease, Intravenous immunoglobulin treatment, Cytokine production, Immunoglobulin production, Monocyte, B cell


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