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Rheumatic heart disease: mediation by complex immune events.
MedLine Citation:
PMID:  21404913     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Rheumatic fever (RF) is an autoimmune disease caused by the Gram-positive bacteria Streptococcus pyogenes following an untreated throat infection in susceptible children. Rheumatic heart disease (RHD), the most serious complication, occurs in 30-45% of RF patients and leads to chronic valvular lesions. Here, we focus on the genes that confer susceptibility for developing this disease. Molecular mimicry mediates the cross-reactions between streptococcal antigens and human proteins. Several autoantigens have been identified, including cardiac myosin epitopes, vimentin, and other intracellular proteins. In heart tissue, antigen-driven oligoclonal T cell expansions probably cause the rheumatic heart lesions. These cells are CD4+ and produce inflammatory cytokines (TNF alpha and IFN gamma). IL-4+ cells are found in the myocardium; however, these cells are very scarce in the valve lesions of RHD patients. IL-4 is a Th2-type cytokine and plays a regulatory role in the inflammatory response mediated by Th1 cytokines. Our findings indicate that the Th1/Th2 cytokine balance has a role in healing myocarditis while the low numbers of IL-4-producing cells in the valves probably induced the progressive and permanent valve damage.
Authors:
L Guilherme; K F Köhler; J Kalil
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Advances in clinical chemistry     Volume:  53     ISSN:  0065-2423     ISO Abbreviation:  Adv Clin Chem     Publication Date:  2011  
Date Detail:
Created Date:  2011-03-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985173R     Medline TA:  Adv Clin Chem     Country:  United States    
Other Details:
Languages:  eng     Pagination:  31-50     Citation Subset:  IM    
Affiliation:
Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil. luizagui@usp.br
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