Abstract 16148: Possible Implication of Oxidative Stress in Development of Coronary Vascular Lesions in Kawasaki Disease

Abstract

Introduction: Kawasaki disease (KD) is an acute systemic pan-vasculitis prevalent in infants and consequently causes coronary arterial lesions (CALs). Furthermore, it has been reported that CALs in KD may increase the risk of early-onset and progression of arteriosclerosis. In this study, we evaluated the possible implication of oxidative stress (OS) in morbid state and developing vascular lesions by measuring the balance between oxidative stress and antioxidative activity. Methods: Nineteen patients were enrolled to evaluate the dynamics of OS in the acute phase. All patients were treated with IVIG and aspirin. Thirteen patients responded well to IVIG and six did not respond well. Reactive oxygen metabolites (ROM) and biological antioxidant potential (BAP) were measured before (point A), two days (point B) and 1~2 weeks (point C) after IVIG administration, using FREE. OS balance in the chronic-phase was examined in 42 late-phase KD patients (mean age; 16.5 years-old), who included 16 patients without CAL (group D), eight with transient CAL (group E), and 18 with persistent CALs (group F). Results: In the acute phase of KD, OS was enhanced. ROMs in good response group significantly decreased between points A and B, and points B and C (p< 0.05 and p< 0.01, respectively). In poor response group, there was no significant difference in ROM between points A and B. BAP in good response group significantly increased between points A and C (p < 0.01), but not in poor response group. BAP at point A was significantly lower in the poor response group than the good response (p < 0.01). No statistically significant differences in ROM and BAP were observed in groups D ~ F, but ROM was the lowest in group F. Potential antioxidative activity (BAP/dROMs) was significantly higher in group F compared with those in groups D and E (p< 0.05). In KD patients with CALs, ROM was the lowest in the combined therapy with antiplatelet medicine plus statin and/or warfarin, and AR was the highest. Conclusions: In KD, OS was significantly enhanced in acute phase, and changes in ROM and BAP are clinically useful for evaluating and predicting the effects of IVIG therapy. Furthermore, it was suggested that combined treatment of statin or warfarin may increase potential antioxidant activity.