title: Urine proteomics for discovery of improved diagnostic markers of Kawasaki disease.
abstract: Kawasaki disease (KD) is a systemic vasculitis of unknown etiology. Absence of definitive diagnostic markers limits the accuracy of clinical evaluations of suspected KD with significant increases in morbidity. In turn, incomplete understanding of its molecular pathogenesis hinders the identification of rational targets needed to improve therapy. We used high-accuracy mass spectrometry proteomics to analyse over 2000 unique proteins in clinical urine specimens of patients with KD. We discovered that urine proteomes of patients with KD, but not those with mimicking conditions, were enriched for markers of cellular injury such as filamin and talin, immune regulators such as complement regulator CSMD3, immune pattern recognition receptor muclin, and immune cytokine protease meprin A. Significant elevations of filamin C and meprin A were detected in both the serum and urine in two independent cohorts of patients with KD, comprised of a total of 236 patients. Meprin A and filamin C exhibited superior diagnostic performance as compared to currently used markers of disease in a blinded case-control study of 107 patients with suspected KD, with receiver operating characteristic areas under the curve of 0.98 (95% confidence intervals [CI] of 0.97-1 and 0.95-1, respectively). Notably, meprin A was enriched in the coronary artery lesions of a mouse model of KD. In all, urine proteome profiles revealed novel candidate molecular markers of KD, including filamin C and meprin A that exhibit excellent diagnostic performance. These disease markers may improve the diagnostic accuracy of clinical evaluations of children with suspected KD, lead to the identification of novel therapeutic targets, and allow the development of a biological classification of Kawasaki disease.
authors.affiliation: Division of Hematology/Oncology, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Kentsis
authors.forename: Andrew
authors.initials: A
authors.lastname: Shulman
authors.forename: Saima
authors.initials: S
authors.lastname: Ahmed
authors.forename: Eileen
authors.initials: E
authors.lastname: Brennan
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Lee
authors.forename: Susan
authors.initials: S
authors.lastname: Lipsett
authors.forename: Joao A
authors.initials: JA
authors.lastname: Paulo
authors.forename: Fatma
authors.initials: F
authors.lastname: Dedeoglu
authors.forename: Robert
authors.initials: R
authors.lastname: Fuhlbrigge
authors.forename: Richard
authors.initials: R
authors.lastname: Bachur
authors.forename: Gary
authors.initials: G
authors.lastname: Bradwin
authors.forename: Moshe
authors.initials: M
authors.lastname: Arditi
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sundel
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Hanno
authors.initials: H
authors.lastname: Steen
authors.forename: Susan
authors.initials: S
authors.lastname: Kim
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000652:urine*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003285:Contractile Proteins / Q000652:urine; D005260:Female; D064448:Filamins; D006801:Humans; D007223:Infant; D008297:Male; D013058:Mass Spectrometry; D008666:Metalloendopeptidases / Q000652:urine; D051379:Mice; D008810:Mice, Inbred C57BL; D008840:Microfilament Proteins / Q000652:urine; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000652:urine*; D040901:Proteomics
chemical_list: D015415:Biomarkers; D003285:Contractile Proteins; D064448:Filamins; D008840:Microfilament Proteins; D008666:Metalloendopeptidases; C053833:meprin A