Objective To investigate the histone acetylation status of forkhead box P3(Foxp3) gene and its roles in immunological pathogenesis of Kawasaki disease(KD). Methods Forty-two children with KD and 32 age-matched healthy children consented to participate in this study as a control group.Co-immunoprecipitation and real-time PCR were performed to determine acetylation levels of histone H4 associated with Foxp3 gene and binding abilities of Kruppel like factor 10(KLF10) and p300/CBP-associated factor (PCAF) with Foxp3 gene in CD4+ T cells.The proportion of CD4+ CD25high Foxp3+ cells (Treg) and protein levels of Foxp3, KLF10, PCAF, phosphated SMAD family member 2/3(pSmad2/3) and itchy E3 ubiquitin protein ligase(Itch) were analyzed by flow cytometry.Quantitative real-time PCR was used to evaluate the levels of Foxp3, transforming growth factor-β1 receptor Ⅱ (TGF-βRⅡ), transforming growth factor-β1 receptor Ⅰ(TGF-βRⅠ), tyrosine kinase 2(Tyk2), SH2 domain-containing protein-tyrosine phosphatase-2(SHP2) and cytotoxic T-lymphocyte-associated protein 4(CTLA4) mRNA in Treg.Plasma concentrations of TGF-β and interleukin-6(IL-6) were measured by enzyme-linked immunosorbent assay. Results (1)Compared with the control group, the proportion of Treg, expression levels of Foxp3 and TGF-β, and histone acetylation levels of Foxp3 promoter decreased remarkably during acute KD, and the differences were all statistically significant(all P<0.05), and restored after IVIG therapy(all P<0.05). Meanwhile, the 5 indexes aforementioned in KD patients with coronary artery lesions (KD-CAL+ ) were lower than those without coronary artery lesions(KD-CAL-), and the differences were all statistically significant (all P<0.05). (2)Compared with the control group, protein levels of KLF10 and PCAF in Treg cells, and their binding abilities with Foxp3 gene were significantly down-regulated during acute KD, and the differences were all statistically significant(all P<0.05), and restored to some extent after IVIG treatment(all P<0.05). Positive correlations between protein levels of KLF10 and PCAF, and mRNA level of Foxp3 were detected in acute KD patients (r=0.47, 0.59, all P<0.05). Furthermore, protein levels of KLF10 and PCAF and their binding abilities with Foxp3 gene in KD-CAL+ group were lower than those in KD-CAL- group, and the differences were all statistically significant(all P<0.05). (3) Compared with the control group, the plasma concentration of TGF-β and expressions of TGF-βRⅡ/Ⅰ, pSmad2/3, Itch, CTLA4 and SHP2 in Treg were down-regulated during the acute phase of KD, and the differences were all statistically significant(all P<0.05), as well as plasma concentration of IL-6 and expression its downstream molecule Tyk2 increased remarkably in patients with acute KD(all P<0.05). All the indexes mentioned before restored significantly after IVIG treatment (all P<0.05). Simultaneously, the 7 former indexes in KD-CAL+ group were found to be lower than those in KD-CAL- group, while 2 indexes of the latter in KD-CAL+ group were higher than those in KD-CAL- group, and the differences were all statistically significant(all P<0.05). Conclusion Histone hypoacetylation of Foxp3 promoter might be one of the important factors contributing to insufficiency and dysfunction of regulatory T cells during acute Kawasaki disease. Key words: Kawasaki disease; Foxp3; Histone; Acetylation; Immune