1. Table: Details of patients with KD
T helper 17 (Th17) and T regulatory (Treg) cells in children with Kawasaki disease – experience from a tertiary care centre in North India
Sagar Bhattad1, Amit Rawat1, Biman Saikia2, Ranjana W.Minz2, Jitendra Shandilya1, Surjit Singh2
1Pediatric Allergy and Immunology Unit, Dept of Pediatrics, 2 Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Male: female ratio amongst cases - 4:1
Mean age at onset of KD years
Youngest child - 6 months old
Mean duration of fever at presentation days
60% of children presented beyond 10 days of onset of fever
Introduction
Results
Table: Details of patients with KD
Total patients 10
Age (Mean)
4.45 years (6 months – 9 years)
Sex (M:F)
8:2
Duration of fever (Mean/S.D)
10.7 (4.9) days
Conjunctival injection
5 (50%)
Oral mucosal changes
7 (70%)
Cervical lymphadenopathy
6 (60%)
Rash
Extremity edema
Peeling of skin
10 (100%)
Irritability
Arthritis/arthralgia
2 (20%)
Coronary artery dilatation
3 (30%)
Coronary aneurym
Myocarditis
1 (10%)
Jaundice
Acute kidney injury
Sterile pyuria
Recurrent KD
Incomplete KD
4 (40%)
IVIg resistant KD
Severe KD warranting additional therapy (infliximab)
Family history of KD
Kawasaki disease (KD) is an acute necrotizing vasculitis with predilection for coronary arteries
Acute KD has been associated with abnormalities in T-helper 17 (Th17)/ T-regulatory (Treg) cells and a high Th17/low Treg profile predict poor outcome in acute KD
Objectives
To estimate Th17 and Treg cells in children with acute KD
Cases (Pre- IVIg)
Cases (Post-IVIg)
Febrile controls
Controls
Th17 cells
2.58 %
1.88%
1.57 %
2 %
Treg cells
0.99 %
2.64%
1.96 %
2.37 %
Methods
Study setting: Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh
Study duration: Jan – Dec 2015
Study population: 10 children with acute KD
Controls: 17 healthy controls and 9 febrile controls (not suffering from KD)
Th17 and Treg cells were estimated at admission (pre-IVIg) and at 4-8 weeks of follow-up in cases. Samples for febrile controls were drawn only at the first instance.
Estimation of Th17 and Treg cells was carried out by flow cytometry using the Th17/Treg phenotyping kit that contains PerCP-Cy5.5 labeled anti-CD4, Phycoerythrin (PE) labeled anti-IL-17 and AlexaFluor labeled anti-FoxP3 antibody
Parameter
Mean (S.D)
Hemoglobin
96 g/L (15)
Leukocyte counts
17.79 x 109/L (9.37 x 109)
Platelet counts
652 x 109/L (273 x 109)
ESR
57 mm/1st hr (23)
CRP
62 mg/L (89)
Serum Sodium
136.5 meq/L (4.1)
Albumin
3.2 g/dl (0.74)
AST
32.8 (7.1)
ALT
29 (7.6)
Representative density plot to show gating of cells and determination of Th17 and Tregs by flow cytometric analysis in a child with KD
Comparision of Th17 and Treg proportions at admission (pre-IVIG) in cases with and without CAA
Pre-IVIg
KD-CAA+
KD-CAA‑
P-value
Th17
2.61 %
2.56 %
0.732
Treg
1.17 %
0.67 %
0.569
Conclusions
Comparision of Th17 and Treg proportions at admission (post-IVIG) in cases with and without CAA
Th17 cells were elevated and Tregs were reduced during acute KD as compared to febrile and healthy controls; the difference, however, was not statistically significant
Larger studies that evaluate Th17 and Tregs in KD are needed to confirm the differences of statistical significance
Post-IVIg
KD-CAA+
KD-CAA‑
P-value
Th17
1.78 %
1.98 %
0.732
Treg
3.45 %
2.63 %