Immunologic and immunogenetic studies in rheumatic fever and rheumatic heart disease
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In order to evaluate all the important limbs of the immune system in the same patient population with rheumatic fever (RF) and rheumatic heart disease (RHD) cellular and humoral immune parameters as well as the immunogenetic profile in 265 North Indian patients with RHD were evaluated. They were studied for class in HLA antigens and 165 of them were also evaluated for the class II (DR locus) antigen profile. Data obtained was compared with 400 and 134 healthy controls respectively of the same ethnicity. Humoral immune parameters (Serum immunoglobulins IgG, IgA; Serum complement fractions C3, C4, C3d; circulating immune complexes and B lymphocyte numbers) and cellular immune parameters (total leucocyte and lymphocyte counts; T lymphocyte sub-populations-CD4, CD8 counts; lymphocyte migration inhibition to an extracellular streptococcal antigen, streptolysin ’O’) were studied in 23 patients with RF, 21 patients with “inactive” RHD and 20 normal controls. Patients of RHD were noted to have an increased frequency of DR3 (P < 0.001; Relative risk = 2.3) and a decreased frequency of DR2 (P < 0.001; Relative risk = 0.3) as compared to the controls. Patients of RF had evidence of an altered regulatory T cell function (Increased CD4/CD8 ratio) and decreased cell mediated immunity to streptolysin ‘0’. An increased humoral immune response (increased B cell counts, elevated serum IgG, circulating immune complexes and C3d) was noted in patients of RF as well as “inactive” RHD. An integrated pathogenetic model with immune response associated antigens of the DR locus influencing selection of cardiac cross-reactive antigens by the antigen processing macrophages, an altered regulatory T cell function with decreased suppressor T cell activity leading to an abnormal immune response is proposed to explain the pathogenesis of RF.
Key WordsRheumatic Fever Rheumatic Heart Disease Human Leucoyte Antigens Humoral Immunity Cell Mediated Immunity
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- 2.Read S, Zabriskie JB. Immunologic concepts in rheumatic fever. In: Zabriskie JB, ed.Clinical Immunology of the Heart. New York, John Wiley and Sons, 1981; 51–88.Google Scholar
- 3.Ad hoc committee on rheumatic fever and bacterial endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever.Circulation 1965; 32: 664–669.Google Scholar
- 4.Rotta J, Sharma KB, Biorca R, Havlicek J.Manual of reference procedures in streptococcal bacteriology and serology. New Delhi: World Health Organisation (South-East Asia Region), 1976.Google Scholar
- 6.Danilovs AA, Ayoub G, Terasaki PI. B lymphocyte isolation by Thrombin-nylon wool. In: Terasaki PI (ed.)Histocompatibility testing 1980. Los Angeles : UCLA Tissue Typing Laboratory, 1980.Google Scholar
- 9.Gupta RC, Badhwar AK, Berrios X, Bisno AI. C-Reactive protein, streptolysin ‘O’ antibodies in immune complexes isolated from sera of patients with acute rheumatic fever (abstr.)Arthritis Rheum 1986; 29 (4) suppl: 530, S30.Google Scholar
- 10.Falk JA, Fleischmann JL, Zabriskie JB, Falk RE. A study of HLA antigen phenotype in rheumatic fever and rheumatic heart diseases.J Rheumatol 1975; 2: 319–322.Google Scholar
- 12.Leirisalo M, Laitinen O, Tiilikinen A. HLA phenotypes in patients with rheumatic fever, rheumatic heart diseases and yearsinia arthritis.J Rheumatol 1977; 4 suppl 3: 78–83.Google Scholar
- 13.Leirisalo M, Koiruranta P, Laitinen O. Rheumatic fever and its sequelae in children — A follow up study with HLA.J Rheumatol 1980; 21: 506–510.Google Scholar
- 17.Editorial. New views on HLA and disease.Lancet 1985; 1 ; 559–561.Google Scholar