title: Inflammatory cytokine profile in children with severe acute respiratory syndrome.
abstract: OBJECTIVE
  To study the inflammatory cytokine profile in children with severe acute respiratory syndrome (SARS) and to investigate whether monoclonal antibody to tumor necrosis factor-alpha (TNF-alpha) could be considered for treatment of these patients.
  
  
  METHODS
  Plasma inflammatory cytokine concentrations (interleukin [IL]-1beta, IL-6, IL-8, IL-10, IL-12p70, and TNF-alpha) were monitored longitudinally on admission, immediately before corticosteroids, and 1 to 2 days and 7 to 10 days after the drug treatment in a cohort of pediatric patients (n = 8) with virologic confirmed SARS-associated coronavirus infection. None of the patients required mechanical ventilation or intensive care treatment. All children except 1 (patient 3) received corticosteroids.
  
  
  RESULTS
  Plasma IL-1beta levels (excluding patient 3) were substantially elevated immediately before (range: 7-721 ng/L) and 7 to 10 days after (range: 7-664 ng/L) corticosteroid treatment. In contrast, the plasma concentrations of other key proinflammatory cytokines, including IL-6 and TNF-alpha, were not overtly increased in any of the patients throughout the course of illness. In addition, plasma IL-10 concentration was significantly lower 1 to 2 days and 7 to 10 days after corticosteroid treatment, compared with the immediate pretreatment level. Similarly, plasma IL-6 and IL-8 concentrations were significantly decreased 7 to 10 days after the drug treatment.
  
  
  CONCLUSIONS
  Pediatric SARS patients have markedly elevated circulating IL-1beta levels, which suggests selective activation of the caspase-1-dependent pathway. Other key proinflammatory cytokines, IL-6 and TNF-alpha, showed only mildly elevated levels at the initial phase of the illness. The current evidence does not support the use of TNF-alpha monoclonal antibody in this group of children.
authors.affiliation: Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. pakcheungng@cuhk.edu.hk
authors.forename: Pak C
authors.initials: PC
authors.lastname: Ng
authors.forename: Christopher W K
authors.initials: CW
authors.lastname: Lam
authors.forename: Albert M
authors.initials: AM
authors.lastname: Li
authors.forename: Chun K
authors.initials: CK
authors.lastname: Wong
authors.forename: Frankie W T
authors.initials: FW
authors.lastname: Cheng
authors.forename: Ting F
authors.initials: TF
authors.lastname: Leung
authors.forename: Ellis K L
authors.initials: EK
authors.lastname: Hon
authors.forename: Iris H S
authors.initials: IH
authors.lastname: Chan
authors.forename: Chi K
authors.initials: CK
authors.lastname: Li
authors.forename: Kitty S C
authors.initials: KS
authors.lastname: Fung
authors.forename: Tai F
authors.initials: TF
authors.lastname: Fok
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007375:Interleukin-1 / Q000097:blood; D008297:Male; D015846:Monokines / Q000097:blood*; D045169:Severe Acute Respiratory Syndrome / Q000188:drug therapy / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D007375:Interleukin-1; D015846:Monokines; D014409:Tumor Necrosis Factor-alpha