title: Rheumatic heart disease: 15 years of clinical and immunological follow-up.
abstract: Rheumatic fever (RF) is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD), the major sequel of RF, occurs in 30%-45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximately 90% of early childhood valvular surgery in the country. In this study, we present a 15-year clinical follow-up of 25 children who underwent surgical valvular repair. Histopathological and immunological features of heart tissue lesions of RHD patients were also evaluated. The patients presented severe forms of RHD with congestive symptoms at a very young age. Many of them had surgery at the acute phase of RF. Histological analysis showed the presence of dense valvular inflammatory infiltrates and Aschoff nodules in the myocardium of 21% of acute RHD patients. Infiltrating T-cells were mainly CD4+ in heart tissue biopsies of patients with rheumatic activity. In addition, CD4+ and CD8+ infiltrating T-cell clones recognized streptococcal M peptides and cardiac tissue proteins. These findings may open the possibilities of new ways of immunotherapy. In addition, we demonstrated that the surgical procedure during acute phase of the disease improved the quality of life of young RHD patients.
authors.affiliation: Heart Institute (InCor), University of São Paulo, Brazil.
authors.forename: Roney O
authors.initials: RO
authors.lastname: Sampaio
authors.forename: Kellen C
authors.initials: KC
authors.lastname: Fae
authors.forename: Lea M F
authors.initials: LM
authors.lastname: Demarchi
authors.forename: Pablo M A
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: Vera D
authors.initials: VD
authors.lastname: Aiello
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Spina
authors.forename: Ana C
authors.initials: AC
authors.lastname: Tanaka
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Oshiro
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.forename: Luiza
authors.initials: L
authors.lastname: Guilherme
mesh_terms: D000293:Adolescent; D000942:Antigens, Bacterial / Q000276:immunology; D001425:Bacterial Outer Membrane Proteins / Q000276:immunology; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology; D002352:Carrier Proteins / Q000276:immunology; D002648:Child; D002999:Clone Cells / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009206:Myocardium / Q000473:pathology; D011788:Quality of Life; D012214:Rheumatic Heart Disease / Q000276:immunology* / Q000473:pathology*
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; C014689:streptococcal M protein