Molecular mimicry in the autoimmune pathogenesis of rheumatic heart disease |
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Authors: | Guilherme Luiza Kalil Jorge Cunningham Madeleine |
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Affiliation: | Heart Institute-InCor, University of S?o Paulo, School of Medicine, S?o Paulo, Brazil. |
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Abstract: | Molecular mimicry is a hallmark of the pathogenesis of rheumatic fever where the streptococcal group A carbohydrate epitope, N-acetyl glucosamine, and the a-helical coiled-coil streptococcal M protein structurally mimic cardiac myosin in the human disease, rheumatic carditis, and in animal models immunized with streptococcal M protein and cardiac myosin. Recent studies have unraveled the potential pathogenic mechanisms by which the immune response against the group A streptococcus attacks the rheumatic valve leading to chronic rheumatic heart disease. Both B- and T-cell responses are involved in the process, and evidence for the hypotheses of molecular mimicry and epitope spreading are reviewed. |
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