Can we prevent long term cardiac damage in Kawasaki disease? Lessons from Lactobacillus casei cell wall-induced arteritis in mice.

A single intraperitoneal injection of sonicated cell walls from group B Lactobacillus casei (LC) produces an acute inflammatory coronary arteritis in mice that closely resembles the coronary arteritis found in children with Kawasaki Disease (KD). The coronary arteritis is accompanied in its early stages by pancarditis and valvulitis, and in its later stages by coronary artery aneurysms, stenoses, and myocardial infarctions. The importance of this model is two-fold. First, it provides the opportunity to study the natural history of coronary artery disease over a relatively short life span. Second, it provides a model system in which the effects of immunological and pharmacological interventions may be tested without putting human life at risk. Studies to date indicate that inflammatory coronary arteritis such as occurs in this model and in children with KD is associated with the accelerated development of coronary artery insufficiency and premature death from cardiovascular disease. The use of immunomodulators or other agents early in the disease course to reduce the frequency and severity of the coronary arteritis appears to reduce the incidence of premature death in this mouse model and may reduce the consequences of KD as well.