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Comment
. 2022 Jul 20;118(9):e62-e65.
doi: 10.1093/cvr/cvac071.

Can we diagnose acute rheumatic fever early to maximize the success of secondary prophylaxis in rheumatic heart valve disease?

Livia S A Passos  1 , Victor Nizet  2 , Robert A Levine  3 , Elena Aikawa  1   4
Affiliations
Comment

Can we diagnose acute rheumatic fever early to maximize the success of secondary prophylaxis in rheumatic heart valve disease?

Livia S A Passos et al. Cardiovasc Res. .
No abstract available

Keywords: autoimmunity; heart valves; rheumatic fever; rheumatic heart valve disease; valvular damage.

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Figures

Figure 1
Figure 1
Schematic representation of the mechanisms of the pathogenesis of ARF and RHVD. Following GAS invasion of the pharyngeal epithelium, antigen presenting cells (APCs) recognize and process bacterial antigens and present them to T cells (CD4 and CD8 T cells). Some of these cells became auto-reactive clones and can recognize epitopes in heart resulting in valve dysfunction. T cells are sources of the immunostimulatory protein ProTα, which is elevated in blood of patients with RHVD and thus can serve as potential biomarker of RHVD. ProTα facilitates CD8 T cell recognition of cross-reactive collagen epitopes in RHVD and therefore could be a target for immune-based interventions. Echocardiographic screening can detect early mild valvular changes that termed ‘latent’ RHVD that could progress to permanent heart valve damage. Secondary prophylaxis can prevent recurrent GAS infection and incremental valve damage associated with amplification of pathogenic immune responses by antigen re-exposure. Discovery of ARF biomarkers could significantly improve early disease diagnosis and increase the success rate of secondary prophylaxis and clinical intervention.
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Comment on

  • Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease.
    Beaton A, Okello E, Rwebembera J, Grobler A, Engelman D, Alepere J, Canales L, Carapetis J, DeWyer A, Lwabi P, Mirabel M, Mocumbi AO, Murali M, Nakitto M, Ndagire E, Nunes MCP, Omara IO, Sarnacki R, Scheel A, Wilson N, Zimmerman M, Zühlke L, Karthikeyan G, Sable CA, Steer AC. Beaton A, et al. N Engl J Med. 2022 Jan 20;386(3):230-240. doi: 10.1056/NEJMoa2102074. Epub 2021 Nov 13. N Engl J Med. 2022. PMID: 34767321 Clinical Trial.

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