Direct cardiac and vascular actions of adrenomedullin in conscious sheep

OBJECTIVE: Patients with Kawasaki disease mount an immune response directed to their abnormally stimulated vascular endothelium, that is associated with vascular inflammation and injury and a predisposition to arterial aneurysm formation. This suggests that specific pro-inflammatory cytokines may mediate these hyperreactive responses. The selective chemoattractant and activation effects of chemokines on lymphocytes identifies them as potential candidates in mediating selective inflammatory processes in Kawasaki disease. We examined peripheral blood from patients with Kawasaki disease for chemokine gene expression. METHODS: Consecutive samples from 14 patients during the acute, subacute, and convalescent phases of their illness were collected and elaborated for RANTES, macrophage inflammatory protein-1 beta (MIP-1 beta) and monocyte chemotactic protein-1 (MCP-1) expression. RESULTS: RANTES and MCP-1 gene expression levels were significantly elevated in 12 of the 14 patients, and MIP-1 beta gene expression was elevated in 13 of the 14 patients. There was no obvious correlation between clinical phase of the disease and chemokine expression level, yet elevated expression levels were detected in all phases, including the convalescent phase, when laboratory evidence of lymphocyte activation has been shown to return to normal. Serial samples showed persistence or increased expression of chemokine genes into the convalescent phase in patients with coronary artery lesions. CONCLUSION: Chemokine mediated inflammatory events may persist in the convalescent phase of Kawasaki disease and may contribute to further risk of vascular endothelial cell injury, specifically coronary aneurysm formation.