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Arab Y, Harahsheh AS, Dahdah N, El-Kholy N, Abed MY, Abu Al-Saoud SY, Agha HM, Alahmadi F, Alamer SR, Awadhi ZA, Ali S, Ali MT, Alrabte H, Al-Saloos H, Al-Senaidi KS, Alzyoud R, Awidat N, Bouayed K, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, Elrugige N, Fitouri Z, Kotby A, Ladj MS, Bekkar M, Mouawad P, Salih AF, Suleiman M, Choueiter NF. Kawarabi: Administrative Structuring of a Multicenter Research Collaborative to Study Kawasaki Disease in the Arab Countries. World J Pediatr Congenit Heart Surg 2024; 15:177-183. [PMID: 37981829 DOI: 10.1177/21501351231205570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Kawasaki disease (KD), the leading cause of acquired heart disease in children in developed countries, merits conducting detailed studies in Arab countries. We introduce Kawarabi, as a multicenter research collaborative effort dedicated to improving diagnosis, care, and outcome of children and adults with KD in the Arab world. During the COVID-19 pandemic, there emerged a new multisystem inflammatory syndrome in children; a disease similar to KD. This highlighted the challenges that Arab physicians face in diagnosing and managing children with KD and KD-like illnesses. Kawarabi brings together experts in North America and Arab nations to study this family of diseases in a not-for-profit, voluntary scientific collaborative setting. Bylaws addressing the vision, objectives, structure, and governance of Kawarabi were established, and vetted by the 45 organizing members in 2021. An initial scientific publication showed evidence of a decreased level of awareness of the disease in the general population, as well as the lack of access to resources available for physicians caring for children with KD in Arab countries. Kawarabi has since held several educational webinars and an inaugural yearly meeting. The groundwork for future initiatives targeted at increasing awareness and understanding of the management and the long-term outcomes of children with KD in the region was established. Data on KD in the Arab world are lacking. Kawarabi is a multicenter research collaborative organization that has the unique resources, diversified ethnic makeup, and energy, to accomplish significant advances in our understanding and management of KD and its variants.
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Affiliation(s)
- Yousra Arab
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Montreal, Canada
- Professor of Pediatrics - Université de Montréal, Montreal, Canada
| | | | - Maysam Y Abed
- Al-Ramadi Maternity and Child Teaching Hospital, Al-Ramadi, Iraq
| | - Sima Y Abu Al-Saoud
- Department of Pediatrics, Faculty of Medicine, Makassed Hospital, Al-Quds University, East- Jerusalem, Palestine
| | - Hala M Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Fahad Alahmadi
- King Faisal Specialist Hospital and Research Center, Taibah University, Madinah, Saudi Arabia
| | - Suad R Alamer
- Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Centre, Awali, Bahrain
| | - Zainab Al Awadhi
- Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Sulafa Ali
- Sudan Heart Center, University of Kharthoum, Kharthoum, Sudan
| | | | - Hanifa Alrabte
- Pediatric Cardiology Department, Tripoli Children Hospital, Tripoli, Libya
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | - Khalfan S Al-Senaidi
- Division of Pediatric Cardiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children's Hospital, Amman, Jordan
| | | | - Kenza Bouayed
- Abderrahim Harouchi Mother-Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | - Asma Bouaziz
- Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Department of Pediatrics, University Hospital Mustapha Bacha, Algiers University, Alger, Algeria
| | - Mona M El Ganzoury
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M Elmarsafawy
- Division of Pediatric Cardiology, Children's Hospital, Mansoura University, Mansoura, Egypt
| | - Najat Elrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Division of Rheumatology, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Alyaa Kotby
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed S Ladj
- Department of Pediatrics, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Alger, Algeria
| | - Mokhtar Bekkar
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Oran, Oran, Algeria
| | - Pierre Mouawad
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F Salih
- Pediatric Cardiology Department, Children's Heart Hospital-Sulaimani College of Medicine, Sulaimani University, Al-Sulaimaniyah, Iraq
| | | | - Nadine F Choueiter
- Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine, Mount Sinai Kravis Children's Hospital, New York, NY, USA
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Alzyoud R, El-Kholy N, Arab Y, Choueiter N, Harahsheh AS, Aselan AS, Kotby A, Bouaziz A, Salih AF, Abushhaiwia A, Alahmadi F, Agha HM, Elmarsafawy HM, Alrabte H, Al-Saloos H, Boudiaf H, Hijazi I, Bouayed K, Al Senaidi KS, Boughammoura L, Jalal M, Ladj MS, Abu-Shukair ME, ElGanzoury MM, Hammadouche N, Elsamman N, Mouawad P, Boukari R, Benalikhoudja N, Jdour S, Abu Al-Saoud SY, Touri SN, Kammoun T, Fitouri Z, Dahdah N. Access to Care and Therapy for Kawasaki Disease in the Arab Countries: A Kawasaki Disease Arab Initiative (Kawarabi) Multicenter Survey. Pediatr Cardiol 2023:10.1007/s00246-023-03166-1. [PMID: 37126143 DOI: 10.1007/s00246-023-03166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
Kawasaki Disease (KD) is still the most common acquired heart disease in children below the age of five years; it has been well described in the developed world; however, data from the Arab world are limited to case reports or single-center case series. In an effort of optimizing KD research in the Arab world, a group of physicians and researchers established the KD Arab Initiative (Kawarabi) in 2021, and published the first survey, which showed disparities in the availability of intravenous immunoglobulin (IVIG); this had prompted Kawarabi to assess the access to care and therapy of KD patients in Arab countries. A 32 structured questions survey was conducted in thirteen Arab countries and addressed KD patients' access to healthcare in urban and rural settings. The survey results showed that access to care was uniform across large, mid-size cities and rural areas in 7/13 (54%) countries, while in 6/13 (46%) countries, it was in favor of large and mid-size cities over rural areas. The quality of medical services received by children with KD in large cities was rated as excellent in 6/13 or good in 7/13 countries compared to fair in 4/13 or poor in 4/13 countries in rural areas. Availability of IVIG was limited (23%) in mid-size cities and almost impossible (23%) in rural areas. The KD patients in mid-size cities and rural areas have limited access to standard healthcare in the Arab world. This survey laid the foundation for future Kawarabi endeavors to improve the care of children with KD.
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Affiliation(s)
- Raed Alzyoud
- Chief of Pediatric Allergy, Immunology and Rheumatology Divsion, Queen Rania Children's Hospital, Amman, Jordan
| | | | - Yousra Arab
- Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ashraf S Harahsheh
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & HealthSciences Cardiology, Washington, DC, USA
| | - Adnan Salem Aselan
- Pediatric Cardiologist, Madinah Maternity and Children Hospital, King Salman Medical City, Al Madinah Al Munawwarah, Saudi Arabia
| | - Alyaa Kotby
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Tunis, Tunisia
| | - Aso F Salih
- HD Cardiology, Pediatric Cardiology Department, Children's Heart Hospital, Sulaimani College of Medicine, Sulaimani University, Sulaimani, Iraq
| | - Awatif Abushhaiwia
- Pediatric Rheumatology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Fahad Alahmadi
- King Faisal Specialist Hospital and Research Center, Pediatric Cardiology, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Hala M Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hala M Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Hanifa Alrabte
- Pediatric Cardiology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Hesham Al-Saloos
- Division of Cardiology, Clinical Pediatrics, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Houda Boudiaf
- Onco-Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Issa Hijazi
- Cardiology Center, King Hussein Medical Center, Amman, Jordan
| | - Kenza Bouayed
- Harouchi, Mother and Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | | | - Lamia Boughammoura
- Pediatric Department of Farhat Hached Hospital, Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Maryam Jalal
- Harouchi, Mother and Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | - Mohamed S Ladj
- Pediatric Department, Faculty of Medicine, Djillali Belkhenchir University Hospital, Algiers University, Algiers, Algeria
| | | | - Mona M ElGanzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nacera Hammadouche
- Pediatric Department, Faculty of Medicine, Djillali Belkhenchir University Hospital, Algiers University, Algiers, Algeria
| | - Nora Elsamman
- Pediatric Cardiology, Pediatrics Department, Ain Shams University, Cairo, Egypt
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rachida Boukari
- Pediatric Department University Hospital, Mustapha Bacha, Algiers, Algeria
| | | | - Salima Jdour
- Pediatric Cardiology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Sima Y Abu Al-Saoud
- Department of Pediatrics, Faculty of Medicine, Makassed Hospital, Al- Quds University, Jerusalem, Palestine
| | | | - Thouraya Kammoun
- Pediatric Department of Hedi Chakar Hospital, Faculté de Médecine de Sfax, Sfax, Tunisia
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis. University Tunis El Manar, Tunis, Tunisia
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, Montréal, Canada.
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Mahmoud S, Fouda EM, Kotby A, Ibrahim HM, Gamal M, El Gendy YG, Zaky EA, Amr NH, El-Ghoneimy DH, Alsharkawy AA, Omar A, El-Meteini M, Elhodhod M. The "Golden Hours" Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C). Glob Pediatr Health 2021; 8:2333794X21990339. [PMID: 33614843 PMCID: PMC7868488 DOI: 10.1177/2333794x21990339] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/19/2020] [Accepted: 01/04/2021] [Indexed: 01/10/2023] Open
Abstract
The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.
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Affiliation(s)
- Sanaa Mahmoud
- Pikeville Osteopathic School of Medicine, Pikeville, KY, USA.,Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | - Eman M Fouda
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | - Alyaa Kotby
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | - Hanan M Ibrahim
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | | | | | | | | | | | | | | | | | - Mostafa Elhodhod
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
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Agha HM, Hamza HS, Kotby A, Ganzoury MEL, Soliman N. Predictors of transient left ventricular dysfunction following transcatheter patent ductus arteriosus closure in pediatric age. J Saudi Heart Assoc 2017; 29:244-251. [PMID: 28983167 PMCID: PMC5623030 DOI: 10.1016/j.jsha.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/08/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To evaluate the left ventricular function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure, and to identify the predictors of myocardial dysfunction post-PDA closure if present. INTERVENTIONS Transcatheter PDA closure; conventional, Doppler, and tissue Doppler imaging; and speckle tracking echocardiography. OUTCOME MEASURES To determine the feasibility and reliability of tissue Doppler and myocardial deformation imaging for evaluating myocardial function in children undergoing transcatheter PDA closure. PATIENTS AND METHODS Forty-two children diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler, and tissue Doppler imaging, and speckle-derived strain rate echocardiography were performed at preclosure and at 48 hours, 1 month, and 6 months postclosure. Tissue Doppler velocities of the lateral and septal mitral valve annuli were obtained. Global and regional longitudinal peak systolic strain values were determined using two-dimensional speckle tracking echocardiography. RESULTS The median age of the patients was 2 years and body weight was 15 kg, with the mean PDA diameter of 3.11 ± 0.99 mm. M-mode measurements (left ventricular end diastolic diameter, left atrium diameter to aortic annulus ratio, ejection fraction, and shortening fraction) reduced significantly early after PDA closure (p < 0.001). After 1 month, left ventricular end diastolic diameter and left atrium diameter to aortic annulus ratio continued to decrease, while ejection fraction and fractional shortening improved significantly. All tissue Doppler velocities showed a significant decrease at 48 hours with significant prolongation of global myocardial function (p < 0.001) and then were normalized within 1 month postclosure. Similarly, global longitudinal strain significantly decreased at 48 hours postclosure (p < 0.001), which also recovered at 1 month follow-up. Preclosure global longitudinal strain showed a good correlation with the postclosure prolongation of the myocardial performance index. CONCLUSION Transcatheter PDA closure causes a significant decrease in left ventricular performance early after PDA closure, which recovers completely within 1 month. Preclosure global longitudinal strain can be a predictor of postclosure myocardial dysfunction.
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Affiliation(s)
- Hala Mounir Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Hala S Hamza
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Alyaa Kotby
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Ain Shams University, Cairo, Egypt
| | - Mona E L Ganzoury
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Ain Shams University, Cairo, Egypt
| | - Nanies Soliman
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Ain Shams University, Cairo, Egypt
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Kotby A, Anwar M, El-Masry OAEA, Awady M, El-Nashar A, Meguid NA. Genetic Variants in the Methylenetetrahydrofolate Reductase Gene in Egyptian Children with Conotruncal Heart Defects and their Mothers. ACTA ACUST UNITED AC 2012. [DOI: 10.3889/mjms.1857-5773.2012.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Guédez Y, Kotby A, El-Demellawy M, Galal A, Thomson G, Zaher S, Kassem S, Kotb M. HLA class II associations with rheumatic heart disease are more evident and consistent among clinically homogeneous patients. Circulation 1999; 99:2784-90. [PMID: 10351973 DOI: 10.1161/01.cir.99.21.2784] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Discrepancies in reported HLA class II associations with rheumatic heart disease (RHD) may have been due to inaccuracies of serological typing reagents and/or lack of defined clinical classification of patients analyzed. The molecular association between HLA and RHD was investigated in patients with defined clinical outcome. METHODS AND RESULTS Class II allele/haplotype distribution was determined in 2 groups of RHD patients (n=88) and a control group (n=59). Patients were divided into the mitral valve disease (MVD) category (ie, those with mitral regurgitation with or without mitral stenosis) and the multivalvular lesions (MVL) category, with impairment of aortic and/or tricuspid valves in addition to mitral valve damage. The MVD category (n=65) accounted for 74% of patients and included significantly fewer recurrent RF episodes compared with MVL patients (P=0.002). CONCLUSIONS Significant increases in DRB1*0701 and DQA1*0201 alleles and DRB1*0701-DQA1*0201 haplotypes were found in patients. Removal of the MVL patients from analysis increased the strength of HLA associations among the MVD sample. The frequency of DQA1*0103 allele was decreased and the DQB1*0603 allele was absent from the patient group, suggesting that these alleles may confer protective effects against RHD. DQ alleles in linkage disequilibrium with DR alleles appear to influence risk/protection effect: whereas the DRB1*13-DQA1*0501-3-DQB1*0301 haplotype showed a trend toward risk, the DRB1*13-DQA1*0103-DQB1*0603 haplotype was absent in the RHD sample. Our data indicate that certain class II alleles/haplotypes are associated with risk or protection from RHD and that these associations appear to be stronger and more consistent when analyzed in patients with relatively more homogeneous clinical manifestations.
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Affiliation(s)
- Y Guédez
- Veterans Affairs Medical Center, The University of Tennessee, Memphis, TN, USA
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El-Demellawy M, El-Ridi R, Guirguis NI, Abdel Alim M, Kotby A, Kotb M. Preferential recognition of human myocardial antigens by T lymphocytes from rheumatic heart disease patients. Infect Immun 1997; 65:2197-205. [PMID: 9169751 PMCID: PMC175303 DOI: 10.1128/iai.65.6.2197-2205.1997] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune sequelae of upper respiratory infections with group A streptococci (GAS). To gain a better understanding of the pathogenesis of these diseases, we examined the in vitro proliferative responses of peripheral blood mononuclear cells (PBMC) from RHD patients to human myocardial proteins in a T-cell Western assay. A number of myocardial proteins fractionated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis were recognized by PBMC from both patients and controls. However, PBMC from a significant percentage of RHD patients (40%) responded to a discrete band of myocardial proteins migrating with an apparent molecular mass of 50 to 54 kDa while none of the control subject PBMC responded to this protein band (P < or = 0.0001). To further investigate the link between infections with GAS and autoimmune carditis, we studied the proliferative responses of PBMC from patients and controls to myocardial proteins before and after in vitro stimulation of the cells with opsonized GAS isolated from ARF patients. Priming of PBMC with rheumatogenic GAS caused the percentage of RHD patients responding to the 50- to 54-kDa myocardial proteins to increase from 43 to 90% (P < or = 0.0284). By contrast, PBMC from control subjects failed to recognize the 50- to 54-kDa myocardial proteins even after stimulation with the opsonized streptococci (P < or = 0.0001). The assay sensitivity was increased from 40 to 90% after priming of a patient's cells with opsonized GAS, but the positive predictive value was 100% in both unprimed and primed cultures. Antibodies generated to partially purified 50- to 54-kDa myocardial proteins did not cross-react with either streptococcal homogenates, purified M protein, myosin, laminin, or vimentin, suggesting a lack of cross-reactivity at the humoral level. This study suggests that the 50- to 54-kDa myocardial proteins contain a putative antigen that is preferentially recognized by T cells from RHD patients and demonstrates that exposure to streptococcal antigens enhances the ability of patients to recognize these proteins.
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Affiliation(s)
- M El-Demellawy
- Veterans Affairs Medical Center and Department of Surgery, The University of Tennessee, Memphis 38104, USA
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