title: Cytoplasmic inclusion bodies are detected by synthetic antibody in ciliated bronchial epithelium during acute Kawasaki disease.
abstract: BACKGROUND
  In developed nations, Kawasaki disease (KD) is the most common cause of acquired heart disease in children. An infectious etiology is likely but has not yet been identified. We have previously reported that oligoclonal immunoglobulin A plasma cells infiltrate acute KD tissues and that synthetic KD antibodies detect a distinctive spheroidal antigen in acute KD ciliated bronchial epithelium.
  
  
  METHODS
  To further characterize the antigen in acute KD bronchi, we examined paraffin-embedded ciliated bronchial epithelium using light microscopy (LM) and transmission electron microscopy (TEM).
  
  
  RESULTS
  The spheroids observed by immunohistochemistry (IHC) are visualized as inclusion bodies with hematoxylin-eosin and nucleic acid stains and in methylene blue/azure II/basic fuchsin trichrome-stained plastic sections, suggesting the presence of both protein and nucleic acid. The structures visualized by LM correspond to homogeneous electron-dense perinuclear inclusion bodies (up to 1.4 microns in diameter) in ciliated bronchial epithelium from 4 patients with acute KD examined by TEM. Inclusion bodies were not present in control bronchial epithelium or in nonciliated cells.
  
  
  CONCLUSIONS
  The antigen detected in acute KD ciliated bronchial epithelium by IHC with synthetic KD antibodies resides in cytoplasmic inclusion bodies that are consistent with aggregates of viral proteins and associated nucleic acid and may derive from the etiologic agent of KD.
authors.affiliation: Department of Pediatrics, Feinberg School of Medicine, Children's Memorial Hospital, Northwestern University, Chicago, IL 60611, USA. a-rowley@northwestern.edu
authors.forename: Anne H
authors.initials: AH
authors.lastname: Rowley
authors.forename: Susan C
authors.initials: SC
authors.lastname: Baker
authors.forename: Stanford T
authors.initials: ST
authors.lastname: Shulman
authors.forename: Linda M
authors.initials: LM
authors.lastname: Fox
authors.forename: Kei
authors.initials: K
authors.lastname: Takahashi
authors.forename: Francesca L
authors.initials: FL
authors.lastname: Garcia
authors.forename: Susan E
authors.initials: SE
authors.lastname: Crawford
authors.forename: Pauline
authors.initials: P
authors.lastname: Chou
authors.forename: Jan M
authors.initials: JM
authors.lastname: Orenstein
mesh_terms: D000911:Antibodies, Monoclonal / Q000276:immunology*; D001980:Bronchi / Q000166:cytology* / Q000648:ultrastructure; D002675:Child, Preschool; D003593:Cytoplasm / Q000648:ultrastructure; D004848:Epithelium / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D002479:Inclusion Bodies / Q000276:immunology / Q000648:ultrastructure*; D007223:Infant; D008297:Male; D046529:Microscopy, Electron, Transmission; D009080:Mucocutaneous Lymph Node Syndrome / Q000209:etiology*
chemical_list: D000911:Antibodies, Monoclonal