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We read with great interest the article by Pouletty et al recently published in your journal.1 The authors described a series of 16 cases with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the Paris area. While the affected children exhibited, in a complete or incomplete form, clinical features of Kawasaki disease (KD), they also presented several features distinct from KD, such as an older age at onset and a higher frequency of myocarditis and/or pericarditis, and of resistance to first treatment with intravenous immunoglobulin (IVIG). Clusters of similar cases have been identified in the USA and other European countries since April 2020.2 3 However, it is still a matter of debate whether PIMS-TS and KD share aetiology and/or pathophysiology, or represent two distinct clinical entities. Herein, we explore the cause behind its outbreak in relation to neutrophil extracellular traps (NETs), a novel killing mechanism of neutrophils.
KD is a multisystem vasculitis that primarily affects coronary arteries of young children, especially in Japan. Although the aetiology of KD remains unclear, it may be triggered by infectious agents, leading to exaggerated activation of immune systems in genetically susceptible children. We first investigated whether KD patients’ serum stimulates NET formation in human neutrophils. NETs are extracellular structures primarily composed of DNA fibres, histones, and antimicrobial granule proteins such as neutrophil elastase and myeloperoxidase. Although NETs can fight diseases, excessive NET formation …
Footnotes
Contributors KY performed the experiments, analysed the data and interpreted the data. AT-K interpreted the data and critically revised the manuscript. KM designed the study, performed the experiments, analysed the data, interpreted the data and wrote the manuscript. All authors reviewed the results and approved the final version of the manuscript.
Funding This research was supported by the research grant for host defense (#200040700004).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.
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