Serum Tenascin-C as a Novel Predictor for Risk of Coronary Artery Lesion and Resistance to Intravenous Immunoglobulin in Kawasaki Disease　– A Multicenter Retrospective Study

• Published in: Circulation Journal Vol. 80; no. 11; pp. 2376 - 2381
• Main Authors: Okuma, Yoshiaki, Suda, Kenji, Nakaoka, Hideyuki, Katsube, Yasuhiro, Mitani, Yoshihide, Yoshikane, Yukako, Ichida, Fukiko, Matsushita, Takeji, Shichino, Hiroyuki, Shiraishi, Isao, Abe, Jun, Hiroe, Michiaki, Yoshida, Toshimichi, Imanaka-Yoshida, Kyoko
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2016
• Subjects: Biomarkers; Biomarkers - blood; Child; Child, Preschool; Coronary artery lesions; Coronary Vessels - metabolism; Drug Resistance; Female; Humans; Immunoglobulins, Intravenous - administration & dosage; Infant; Intravenous immunoglobulin (IVIG) resistance; Kawasaki disease; Male; Mucocutaneous Lymph Node Syndrome - blood; Mucocutaneous Lymph Node Syndrome - drug therapy; Retrospective Studies; Risk Factors; Tenascin - blood; Tenascin-C
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-16-0563

Background:Tenascin-C (TN-C) is an extracellular matrix glycoprotein that is heavily upregulated at sites of inflammation. We conducted a retrospective study to assess the utility of TN-C as a novel biomarker to predict the risk of developing coronary artery lesions (CAL) and resistance to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD).Methods and Results:We collected blood samples of 111 KD patients (IVIG-responder: 89, IVIG-resistant: 22; CAL: 8) and 23 healthy controls, and measured the serum levels of TN-C. TN-C levels on admission were significantly higher in patients than in healthy controls and in patients during convalescence after IVIG administration (69.6 vs. 20.4 vs. 39.7 ng/ml, respectively; P<0.001), and correlated positively with C-reactive protein (P<0.001), neutrophil (percentage; P=0.005), and ALT (P<0.001), and negatively with platelet count (P=0.023) and sodium level (P=0.025). On admission, TN-C levels in patients who later developed CAL were significantly higher than in those without CAL (P=0.010), and significantly higher in IVIG-resistant subjects than in IVIG-responders (P=0.003). The accuracy of TN-C testing for the prediction of IVIG resistance was comparable to that of the Kobayashi score.Conclusions:Serum TN-C could be a biomarker for predicting the risk of developing CAL and IVIG resistance during the acute phase of KD. (Circ J 2016; 80: 2376–2381)