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The Heart of Africa, p. 121-135

DOI: 10.1002/9781119097136.ch7

Heart Disease in Pregnancy, p. 79-95

DOI: 10.1002/9780470994955.ch7

Pediatric Cardiovascular Medicine, p. 905-918

DOI: 10.1002/9781444398786.ch62

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Rheumatic heart disease

Journal article published in 1943 by Soma Weiss, Rosemary Wyber, Loy Wiley, David Vérel, Ana C. Tanaka, Sandra Emiko Oshiro, Pablo M. A. Pomerantzeff, Christina Maria Steger, Simon Stewart, Karen Sliwa, Shanti Nulu, Eloi Marijon, Ana P. Lopez, McCulloch, Sandra Lane and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Heart lesions of rheumatic heart disease (RHD) patients contain T-cell clones that recognize heart proteins and streptococcal M peptides. To functionally characterize heart-infiltrating T lymphocytes, we evaluated their cytokine profile, both directly in situ and in T-cell lines derived from the heart (HIL). Interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-4, and IL-10 expressions were characterized in 20 heart tissue infiltrates from 14 RHD patients by immunohistochemistry. IFN-gamma-, TNF-alpha-, and IL-10-positive cells were consistently predominant, whereas IL-4 was scarce in the valves. In agreement with these data, the in vitro experiments, in which 13 HILs derived from heart samples of eight patients were stimulated with M5 protein and the immunodominant M5 (81-96) peptide, IL-4 was detected in HIL derived from the atrium (three of six) but not from the valve (zero of seven). IFN-gamma and IL-10 production were detected in culture supernatants in 11 of 13 and 6 of 12 HILs, respectively. The predominant IFN-gamma and TNF-alpha expression in the heart suggests that Th1-type cytokines could mediate RHD. Unlike in reversible myocardium inflammation, the significantly lower IL-4 expression in the valvular tissue (P = 0.02) may contribute to the progression of the RHD leading to permanent valvular damage (relative risk, 4.3; odds ratio, 15.8). The lack of IL-4 in vitro production by valve-derived HIL also emphasizes the more severe tissue destruction in valves observed in RHD.