Association of Toll-like receptor 2-positive monocytes with coronary artery lesions and treatment nonresponse in Kawasaki disease

Kang, Soo Jung; Kim, Nam Su

In our study, FTLR2% before initial treatment in IVIG nonrespon ders tended to be higher than that in the IVIG responders. Additio n ally, our results showed that sensitivity in predicting IVIG resistance in patients with KD was comparable between FTLR2% before initial treatment and sIL10. One of the numerous mechanisms of ac tion of IVIG in KD is the inhibition of NFκB activation in CD14 + macrophages and monocytes after IVIG therapy 28) . Because NF κB is involved in the downstream TLR signaling path way, this may indicate that in IVIG nonresponders, the increased FTLR2% before the initial treatment would lead to increased acti vation of NFκB, thus requiring additional treatment with IVIG, but further studies are needed to confirm this. In addition to the known predictive markers of IVIG resistance 7, 8) , monitoring FTLR2% could be useful in predicting IVIG resistance in patients with KD. Early identifica tion of patients at risk of CAL development and IVIG resistance, by monitoring FTLR2%, could supplement existing guidelines for additional intensive treatment strategies, such as the early combi nation of corticosteroid therapy in addition to the initial IVIG treat ment as proposed by Kobayashi et al. 7) , early in the course of KD.