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Serum tenascin-C predicts resistance to steroid combination therapy in high-risk Kawasaki disease: a multicenter prospective cohort study

  • Yoshikane, Yukako1
  • Okuma, Yoshiaki2
  • Miyamoto, Tatsuki1
  • Hashimoto, Junichi1
  • Fukazawa, Ryuji3
  • Kato, Taichi4
  • Takeda, Atsuhito5
  • Suda, Kenji6
  • Matsushita, Takeji2
  • Hiroe, Michiaki2
  • Imanaka-Yoshida, Kyoko7
  • 1 Fukuoka University, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0133, Japan , Fukuoka (Japan)
  • 2 National Center for Global Health and Medicine, Tokyo, Japan , Tokyo (Japan)
  • 3 Nippon Medical School, Tokyo, Japan , Tokyo (Japan)
  • 4 Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan , Nagoya (Japan)
  • 5 Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan , Sapporo (Japan)
  • 6 Kurume University School of Medicine, Fukuoka, Japan , Fukuoka (Japan)
  • 7 Mie University Graduate School of Medicine, Tsu, Mie, Japan , Tsu (Japan)
Published Article
Pediatric Rheumatology
Springer Science and Business Media LLC
Publication Date
Jun 05, 2021
DOI: 10.1186/s12969-021-00562-w
Springer Nature


BackgroundTenascin-C (TN-C) is an extracellular matrix glycoprotein related to tissue inflammation. Our previous retrospective study conducted in 2016 revealed that the serum tenascin-C level was higher in patients with Kawasaki disease (KD) who were resistant to intravenous immunoglobulin (IVIG) and developed coronary artery lesions (CALs). The present study is a prospective cohort study to assess if the serum level of tenascin-C could be used as a novel biomarker to predict the risk of resistance to initial treatment for high-risk patients.MethodsA total of 380 KD patients were registered and provided serum samples for tenascin-C measurement before commencing their initial treatment. Patients who did not meet the inclusion criteria were excluded from analysis; of the 181 remaining subjects, there were 144 low-risk patients (Kobayashi score: ≤4 points) and 37 high-risk patients (Kobayashi score: ≥5 points). The initial treatments for low-risk patients and high-risk patients were conventional therapy (IVIG with aspirin) and prednisolone combination therapy, respectively. The patient clinical and laboratory data, including the serum tenascin-C level, were compared between initial treatment responders and non-responders.ResultsIn the low-risk patients, there was no significant difference in the median levels of serum tenascin-C between the initial therapy responders and non-responders. However, in the high-risk patients, the median serum tenascin-C level in initial therapy non-responders was significantly higher than that in initial therapy responders (175.8 ng/ml vs 117.6 ng/ml).ConclusionsSerum tenascin-C could be a biomarker for predicting the risk of high-risk patients being non-responsive to steroid combination therapy.Trial registrationThis study was a prospective cohort study. It was approved by the ethics committee of each institute and performed in accordance with the Declaration of Helsinki.

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