The aim of our study was to evaluate the efficacy of
infliximab for the treatment of patients with refractory
Kawasaki disease (KD) and investigate the dynamic changes of
cytokines during
infliximab treatment. We have performed a study of
cytokine and proinflammatory molecule levels in 43 KD patients including 18 responders to
IVIG, 14 nonresponders, and 11 patients treated with
infliximab. We determined serum levels of soluble
TNF receptor I (sTNFR I) and
IL-6, as well as
VEGF, damage associated molecular pattern (DAMP) molecules; myeloid-related
protein (MRP)8/MRP14 and
S100A12 sequentially. In eight patients,
fever subsided immediately upon
infliximab treatment. Four patients, who started
infliximab after 12 d of illness, developed coronary artery lesions. Each of the
cytokines was elevated before
infliximab treatment in all patients. Although serum levels of proinflammatory
cytokines decreased dramatically after
infliximab treatment, DAMP molecules and
VEGF and markers of local tissue damage were not suppressed. In contrast, in
IVIG responders all
cytokines decreased markedly after
IVIG treatment. We show that
infliximab is one of the adoptive
therapies in refractory KD patients. Different behaviors of proinflammatory
cytokines and DAMP molecules and
VEGF after
infliximab treatment suggest that
infliximab is effective for suppression of
cytokine-mediated
inflammation, but could not completely block local
vasculitis.