Restoration of PINK1/Parkin-associated mitophagy via the NAD+/SIRT1 axis attenuates Kawasaki disease vasculitis

MITOCHONDRIA, AND THE NAD + /SIRT1 AXIS IN KAWASAKI DISEASEKawasaki disease (KD) is an acute, febrile, systemic vasculitis of unknown etiology that predominantly affects infants and young children, and it remains the leading cause of acquired heart disease in pediatric populations worldwide [1][2][3] .Approximately one quarter of untreated children develop coronary arteritis and/or coronary artery aneurysms, a figure that standard high-dose intravenous immunoglobulin G (IVIG) therapy reduces to roughly 3 to 5 percent.Yet up to 20 percent of patients are IVIGresistant, and these children carry a substantially elevated risk of coronary artery lesions, with a pooled odds ratio of approximately 3.9 compared with IVIGresponsive patients in a recent meta-analysis [4][5][6] .The clinical imperative to find adjunctive or alternative therapies is therefore acute, particularly because IVIG is expensive, of limited availability in low-resource settings, and incompletely protective in a meaningful minority of recipients [7] .