Journal of Clinical Immunology

, Volume 6, Issue 6, pp 433–441

Serial studies on the cellular immune response to streptococcal antigens in acute and convalescent rheumatic fever patients in Trinidad

  • S. E. Read
  • H. F. M. Reid
  • V. A. Fischetti
  • T. Poon-King
  • R. Ramkissoon
  • M. McDowell
  • J. B. Zabriskie
Original Articles


Acute rheumatic fever (ARF) has the characteristics of an autoimmune disease, triggered by cross-reactive antigens shared by the group A streptococcus and a variety of tissues including the heart, endothelium, and basal ganglia. Using two parameters of cellular reactivity, migration inhibition and blastogenic transformation, ARF patients from Trinidad show significant lymphocyte reactivity to streptococcal antigens, particularly those from an ARF associated streptococcal strain. This reactivity, studied over a 2-year period, peaked at 1 to 6 months after the acute onset and remained significantly elevated for at least 2 years. The reactivity is directed mainly toward a nonionic detergent extractable material in the cell membrane. These studies suggest a possible streptococcal strain specificity in ARF and demonstrate persistent sensitization, which explains the increased susceptibility to recurrences in the 2 years following the acute episode.

Key words

Rheumatic fever lymphocyte sensitization cross-reactive antigens group A streptococci 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Read SE, Fischetti VA, Utermohlen V, Falk RE, Zabriskie JB: Cellular reactivity studies to streptococcal antigens in patients with streptococcal infections and their sequelae. J Clin Invest 54:439–450, 1974Google Scholar
  2. 2.
    Rassokhina I, Ananyea L, Bulanora T, Speransky A: Cell-mediated immunity to membrane and cytoplasmic components of group A streptococci in patients with rheumatic fever.In Pathogenic Streptococci, MT Parker (ed). Surrey, England, Reedbooks, 1979, pp 103–104Google Scholar
  3. 3.
    Gross WL, Auerbac G, Hahn G, Schuler M, Schlaak M: The effect of group A streptococcal cell components on peripheral lymphocytes in vitro.In Pathogenic Streptococci, MT Parker (ed). Surrey, England, Reedbooks, 1979, pp 102–103Google Scholar
  4. 4.
    Jones Criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 32:664, 1965Google Scholar
  5. 5.
    Wintrobe MM: Clinical Heamatology, 4th ed. Philadelphia, Lea & Febiger, 1956Google Scholar
  6. 6.
    Mancini G, Carbonara AO, Heremans JF: Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry 2:235, 1965Google Scholar
  7. 7.
    Rantz LZ, Maroney M, DiCaprio JC: Antistreptolysin O response following hemolytic streptococcus infection in early childhood. Arch Intern Med 87:360–371, 1951Google Scholar
  8. 8.
    Anderson HC, McCarty M: Determination of C-reactive protein in the blood as a measure of the disease process in acute rheumatic fever. Am J Med 8:445–455, 1950Google Scholar
  9. 9.
    Karakawa WW, Krause RM: Studies on the immunochemistry of streptococcal mucopeptide. J Exp Med 124:155, 1966Google Scholar
  10. 10.
    Zabriskie JB, Freimer EH: An immunological relationship between the group A streptococcus and mammalian muscle. J Exp Med 124:661–678, 1966Google Scholar
  11. 11.
    van de Rijn I, Zabriskie JB, McCarty M: Group A streptococcal antigens cross-reactive with myocardium: Purification of heart-reactive antibody and isolation and characterization of the streptococcal antigen. J Exp Med 145:579–599, 1977Google Scholar
  12. 12.
    Boyum A: Ficoll-Hypaque method for separating mononuclear cells and granulocytes from human blood. Scand J Clin Lab Invest (Suppl) 77:57–62, 1966Google Scholar
  13. 13.
    Stollerman GH: Pathogenetic issues in the clinical features of rheumatic fever.In Streptococcal Diseases and the Immune Response, SE Read, JB Zabriskie (eds). New York, Academic Press, 1980, pp 3–11Google Scholar
  14. 14.
    Kaplan MH, Frengley JD: Autoimmunity to the heart in cardiac disease. Current concepts of the relation of autoimmunity to rheumatic fever, postcardiotomy and post-infarction syndromes and cardiomyopathies. Am J Cardiol 24:459, 1966Google Scholar
  15. 15.
    Dale JB, Beachey EH: Protective epitopes of group A streptococcal M proteins shared with sarcolemmal membrane proteins of human heart.In Recent Advances in Streptococci and Streptococcal Diseases, Y Kimura, S Kotami, Y Shiokawa (eds). Surrey, England, Reedbooks, 1985, pp 188–189Google Scholar
  16. 16.
    Beachey EH, Dale JB, Seyer M: Chemically synthesized protective epitopes of streptococcal M proteins.In Recent Advances in Streptococci and Streptococcal Diseases, Y Kimura, S Kotami, Y Shiokawa (eds). Surrey, England, Reedbooks, 1985, pp 190–191Google Scholar
  17. 17.
    Hirschorn K, Schribman RR, Verbo S, Gruskin RH: The action of streptolysin S on peripheral lymphocytes of normal subjects and patients with acute rheumatic fever. Proc Natl Acad Sci 52:1151, 1964Google Scholar
  18. 18.
    Gery I, Brand-Auraban A, Benezra D, Jacob A, Davies AM: Transformation of lymphocytes from patients with rheumatic fever by streptolysin S. Clin Exp Immunol 3:717–723, 1968Google Scholar
  19. 19.
    Francis TC, Oppenheim JJ, Barile NJ: Lymphocytic transformation by streptococcal antigens in guinea pigs and man.In Proceedings 3rd Annual Leukocyte Culture Conference, WD Rieke (ed). New York, Appleton-Century-Crofts, 1967, p 501Google Scholar
  20. 20.
    Cippari G, Quagliata F, Ieri A, Taranta A: Lymphocyte transformation with streptolysin S preparations and inhibition of streptolysin S by serum in rheumatic diseases. J Lab Clin Med 80:16–20, 1972Google Scholar
  21. 21.
    Taranta A, Cuppari G, Quagliata F: Dissociation of hemolytic and lymphocyte transforming activities of streptolysin S preparations. J Exp Med 129:605, 1969Google Scholar
  22. 22.
    Sapru RP, Ganguly NK, Sharma S, Chandani RE, Gupta AK: Cellular reaction to group A beta hemolytic streptococcal membrane antigen and its relation to complement levels in patients with rheumatic heart disease. Br Med J 2:422–424, 1977Google Scholar
  23. 23.
    Gray ED, Regelmann WE, Wannamaker LW, El Kholy A, Abdin ZH: Functional alterations in non-T cells in rheumatic heart disease. Clin Exp Immunol 49:488–492, 1982Google Scholar
  24. 24.
    Reid HFN, Read SE, Zabriskie JB, Ramkissoon R, Poon-King T. Suppression of cellular reactivity to group A streptococcal antigens in patients with acute post-streptococcal glomerulonephritis. J Infect Dis 149:841–850, 1984Google Scholar
  25. 25.
    Williams RC, Zabriskie JB, Mahros F, Hasaballa F, Abdin ZH: Lymphocyte surface markers in acute rheumatic fever and post-streptococcal glomerulonephritis. Clin Exp Immunol 116:2110–2114, 1977Google Scholar
  26. 26.
    Zabriskie JB, Hsu KC, Seegal BC: Heart-reactive antibody associated with rheumatic fever: Characterization and diagnostic significance. Clin Exp Immunol 7:147–159, 1970Google Scholar

Copyright information

© Plenum Publishing Corporation 1986

Authors and Affiliations

  • S. E. Read
    • 1
  • H. F. M. Reid
    • 2
  • V. A. Fischetti
    • 3
  • T. Poon-King
    • 4
  • R. Ramkissoon
    • 5
  • M. McDowell
    • 5
  • J. B. Zabriskie
    • 3
  1. 1.Division of Infectious DiseasesHospital for Sick ChildrenTorontoCanada
  2. 2.Trinidad & Tobago Public Health LaboratoryTrinidad and Tobago
  3. 3.The Rockefeller UniversityNew York
  4. 4.The San Fernando General HospitalSan FernandoTrinidad
  5. 5.The Port of Spain General HospitalPort-of-SpainTrinidad

Personalised recommendations