Plasma follistatin-like protein 1 is elevated in Kawasaki disease and may predict coronary artery aneurysm formation.
OBJECTIVE
To determine whether plasma levels of follistatin-like protein 1 (FSTL-1), a pro-inflammatory protein produced by mesenchymal tissue, including cardiac myocytes, correlate with the development of Kawasaki disease (KD) and coronary artery aneurysms (CAA).


METHODS
FSTL-1 plasma levels were measured serially with enzyme-linked immunosorbent assay in 48 patients with KD at time of diagnosis and, when available, 2 weeks, 6 weeks, and 6 months after onset of disease. These were compared with FSTL-1 plasma levels in 23 control subjects. Data were analyzed with generalized estimating equations.


RESULTS
Plasma FSTL-1 levels were elevated in patients with acute KD compared with control subjects (P = .0086). FSTL-1 levels remained significantly elevated at 2 weeks after disease onset, but returned to control levels by 6 months. Seven patients with CAA had significantly higher FSTL-1 levels at the time of diagnosis than patients in whom aneurysms did not develop (P = .0018). Sensitivity and specificity rates for CAA at a specific FSTL-1 cutoff point (178 ng/mL) were 85% and 71%.


CONCLUSIONS
Plasma levels of FSTL-1 are elevated in acute KD and may predict cardiac morbidity in this disease. These results suggest a possible role for FSTL-1 in the formation of CAAs.
Division of Rheumatology, Children's Hospital of Pittsburgh, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Mark
M
Gorelik
David C
DC
Wilson
Yona K
YK
Cloonan
Stanford T
ST
Shulman
Raphael
R
Hirsch
D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology*; D005260:Female; D038702:Follistatin-Related Proteins / Q000097:blood*; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood* / Q000150:complications*; D011237:Predictive Value of Tests
D038702:Follistatin-Related Proteins