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Vieira PPAC, Pereira RF, Branco CEB, Rosa VEE, Vieira MLC, Demarchi LMMF, Silva LS, Guilherme L, Tarasoutchi F, Sampaio RO. Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery-Impact on Late Prognosis. Diagnostics (Basel) 2023; 13:3252. [PMID: 37892073 PMCID: PMC10606607 DOI: 10.3390/diagnostics13203252] [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] [Received: 08/14/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Rheumatic fever (RF) and rheumatic heart disease (RHD) are still highly prevalent, particularly in low- and middle-income countries. RHD is a neglected and underdiagnosed disease for which no specific laboratory diagnostic test is completely reliable. This is a retrospective observational study, which included 118 patients with RHD who underwent cardiac surgery from 1985 to 2018. The aim of this investigation was to evaluate the clinical, epidemiological, echocardiographic and pathological characteristics in two cohorts of RHD patients: one cohort with Aschoff bodies present in their pathological results and the other without such histopathological characteristics. No conventional clinical and laboratory tests for RHD myocarditis were able to identify active carditis during the preoperative phase of valve repair or replacement. Patients who had Aschoff bodies in their pathological results were younger (median age of 13 years (11-24 years) vs. 27 years (17-37 years), p = 0.001) and had higher rate of late mortality (22.9% vs. 5.4%, p = 0.043). In conclusion, the presence of Aschoff bodies in pathological findings may predict increased long-term mortality, emphasizing the importance of comprehensive pathology analysis for suspected myocarditis during heart surgery.
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Affiliation(s)
| | | | - Carlos Eduardo Barros Branco
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Vitor Emer Egypto Rosa
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Marcelo Luiz Campos Vieira
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Lea Maria Macruz Ferreira Demarchi
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Livia Santos Silva
- Clinical Hospital, Santa Marcelina University, Sao Paulo 08270-140, Brazil;
| | - Luiza Guilherme
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Flavio Tarasoutchi
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Roney Orismar Sampaio
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
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2
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Nascimento BR, Beaton AZ, Guilherme L, Sampaio RO. Editorial: Rheumatic fever: 21st century clinical and experimental insights. Front Cardiovasc Med 2023; 10:1190372. [PMID: 37168655 PMCID: PMC10165460 DOI: 10.3389/fcvm.2023.1190372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Affiliation(s)
- Bruno R. Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil
- Correspondence: Bruno R. Nascimento
| | - Andrea Z. Beaton
- Departamento de Cardiopneumologia, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Luiza Guilherme
- Instituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, and the University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Roney O. Sampaio
- Instituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, and the University of Cincinnati School of Medicine, Cincinnati, OH, United States
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3
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de Sá-Rocha LC, Demarchi LMMF, Postol E, Sampaio RO, de Alencar RE, Kalil J, Guilherme L. StreptInCor, a Group A Streptococcal Adsorbed Vaccine: Evaluation of Repeated Intramuscular Dose Toxicity Testing in Rats. Front Cardiovasc Med 2021; 8:643317. [PMID: 34046438 PMCID: PMC8144318 DOI: 10.3389/fcvm.2021.643317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 01/18/2023] Open
Abstract
Streptococcus pyogenes infections continue to be a worldwide public health problem, causing various diseases in humans, with rheumatic fever and rheumatic heart disease being the most harmful manifestations. Impetigo and post-streptococcal glomerulonephritis are also important sequelae of skin infections. We have developed a candidate vaccine epitope (StreptInCor) that presents promising results in diverse animal models. To assess whether the StreptInCor alum-adsorbed vaccine could induce undesirable effects, a certified independent company conducted a repeated intramuscular dose toxicity evaluation in Wistar rats, a choice model for toxicity studies. We did not observe significant alterations in clinical, hematological, biochemical, anatomical, or histopathological parameters due to vaccine administration, even when the animals received the highest dose. In conclusion, repeated intramuscular doses did not show signs of macroscopic or other significant changes in the clinical or histopathological parameters, indicating that StreptInCor can be considered a safe candidate vaccine.
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Affiliation(s)
- Luiz Carlos de Sá-Rocha
- Neuroimmunology Laboratory School of Veterinary Medicine and Animal Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Edilberto Postol
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raquel Elaine de Alencar
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
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4
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Catarino SJ, Andrade FA, Bavia L, Guilherme L, Messias-Reason IJ. Ficolin-3 in rheumatic fever and rheumatic heart disease. Immunol Lett 2020; 229:27-31. [PMID: 33232720 DOI: 10.1016/j.imlet.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/03/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
Rheumatic fever (RF) and chronic rheumatic heart disease (RHD) are complications of oropharyngeal infection caused by Streptococcus pyogenes. Despite the importance of the complement system against infections and autoimmunity diseases, studies on the role of the lectin pathway in RF and RHD are scarce. Thus, our aim was to evaluate the association of ficolin-3 serum levels, FCN3 polymorphisms and haplotypes with the susceptibility to RF and RHD. We investigated 179 patients with a history of RF (126 RHD and 53 RF only) and 170 healthy blood donors as control group. Ficolin-3 serum concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Three FCN3 single nucleotide polymorphisms (SNPs rs532781899, rs28362807 and rs4494157) were genotyped through the sequence-specific PCR method. Lower ficolin-3 serum levels were observed in RF patients when compared to controls (12.81 μg/mL vs. 18.14 μg/mL respectively, p < 0.0001, OR 1.22 [1.12-1.34]), and in RHD in comparison to RF only (RFo) (12.72 μg/mL vs. 14.29 μg/mL respectively, p = 0.016, OR 1.38 [1.06-1.80]). Low ficolin-3 levels (<10.7 μg/mL) were more common in patients (39.5 %, 30/76) than controls (20.6 %, 13/63, p = 0.018, OR = 2.51 [1.14-5.31]), and in RHD (44.4 %, 28/63) than RFo (15.4 %, 2/13, p = 0.007, OR = 3.08 [1.43-6.79]). On the other hand, FCN3 polymorphism/haplotypes were not associated with ficolin-3 serum levels or the disease. Low ficolin-3 levels might be associated with RF, being a potential marker of disease progression.
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Affiliation(s)
- Sandra Jeremias Catarino
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Fabiana Antunes Andrade
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Lorena Bavia
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Iara Jose Messias-Reason
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil.
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5
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Abstract
Acute rheumatic fever (ARF) is caused by an autoimmune response to throat infection with Streptococcus pyogenes in individuals who present some susceptibility genes. Rheumatic heart disease (RHD) is the major sequela and can cause heart failure and premature mortality. The disease is mediated by humoral and cellular immune responses. In this review, we present the major events that can trigger heart lesions.
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Affiliation(s)
- Jorge Kalil
- Department of Clinical Medicine, Clinical Hospital and Heart Institute (InCor), School of Medicine, University of São Paulo; Heart Institute (InCor), School of Medicine, University of São Paulo; Institute for Immunology Investigation, Millennium Institute, São Paulo
| | - Luiza Guilherme
- Department of Clinical Medicine, Clinical Hospital and Heart Institute (InCor), School of Medicine, University of São Paulo; Heart Institute (InCor), School of Medicine, University of São Paulo; Institute for Immunology Investigation, Millennium Institute, São Paulo
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6
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Postol E, Sá-Rocha LC, Sampaio RO, Demarchi LMMF, Alencar RE, Abduch MCD, Kalil J, Guilherme L. Group A Streptococcus Adsorbed Vaccine: Repeated Intramuscular Dose Toxicity Test in Minipigs. Sci Rep 2019; 9:9733. [PMID: 31278336 PMCID: PMC6611820 DOI: 10.1038/s41598-019-46244-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022] Open
Abstract
Streptococcus pyogenes infection continues to be a worldwide public health problem causing various diseases in humans and plays an important role in the pathogenesis of rheumatic fever and rheumatic heart disease. We developed a vaccine candidate to prevent S. pyogenes infections, identified as StreptInCor, that presented promising results in mouse models. A certified and independent laboratory conducted two repeated intramuscular dose toxicity tests (28 days, four weekly injections). The first test, composed of four experimental groups treated with 0 (vehicle), 50, 100 or 200 µg/500 µL StreptInCor, did not show significant alterations in clinical, hematological, biochemical or anatomopathological parameters related to the administration of StreptInCor. In addition to the parameters mentioned above, we evaluated the cardiac function and valves of animals by echocardiography before and after administration of 200 µg/500 µL StreptInCor versus placebo. We did not observe any changes related to StreptInCor administration, including changes in cardiac function and valves in animals, after receiving the highest dose of this vaccine candidate. The results obtained in the two repeated intramuscular dose toxicity tests showed that this vaccine formulation did not induce harmful effects to the tissues and organs studied, indicating that the candidate vaccine is well tolerated in minipigs.
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Affiliation(s)
- Edilberto Postol
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.,Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Luiz C Sá-Rocha
- Neuroimmunology Laboratory School of Veterinary Medicine and Animal Sciences, University of São Paulo, São Paulo, Brazil.,Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Roney O Sampaio
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lea M M F Demarchi
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raquel E Alencar
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.,Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Maria C D Abduch
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.,Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil.,Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil. .,Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil.
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7
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Catarino SJ, Andrade FA, Boldt ABW, Guilherme L, Messias-Reason IJ. Sickening or Healing the Heart? The Association of Ficolin-1 and Rheumatic Fever. Front Immunol 2018; 9:3009. [PMID: 30619357 PMCID: PMC6305461 DOI: 10.3389/fimmu.2018.03009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/05/2018] [Indexed: 12/27/2022] Open
Abstract
Rheumatic fever (RF) and its subsequent progression to rheumatic heart disease (RHD) are chronic inflammatory disorders prevalent in children and adolescents in underdeveloped countries, and a contributing factor for high morbidity and mortality rates worldwide. Their primary cause is oropharynx infection by Streptococcus pyogenes, whose acetylated residues are recognized by ficolin-1. This is the only membrane-bound, as well as soluble activator molecule of the complement lectin pathway (LP). Although LP genetic polymorphisms are associated with RF, FCN1 gene's role remains unknown. To understand this role, we haplotyped five FCN1 promoter polymorphisms by sequence-specific amplification in 193 patients (138 with RHD and 55, RF only) and 193 controls, measuring ficolin-1 serum concentrations in 78 patients and 86 controls, using enzyme-linked immunosorbent assay (ELISA). Patients presented lower ficolin-1 serum levels (p < 0.0001), but did not differ according to cardiac commitment. Control's genotype distribution was in the Hardy-Weinberg equilibrium. Four alleles (rs2989727: c.-1981A, rs10120023: c.-542A, rs10117466: c.-144A, and rs10858293: c.33T), all associated with increased FCN1 gene expression in whole blood or adipose subcutaneous tissue (p = 0.000001), were also associated with increased protection against the disease. They occur within the *3C2 haplotype, associated with an increased protection against RF (OR = 0.41, p < 0.0001) and with higher ficolin-1 levels in patient serum (p = 0.03). In addition, major alleles of these same polymorphisms comprehend the most primitive *1 haplotype, associated with increased susceptibility to RF (OR = 1.76, p < 0.0001). Nevertheless, instead of having a clear-cut protective role, the minor c.-1981A and c.-144A alleles were also associated with additive susceptibility to valvar stenosis and mitral insufficiency (OR = 3.75, p = 0.009 and OR = 3.37, p = 0.027, respectively). All associations were independent of age, sex or ethnicity. Thus, minor FCN1 promoter variants may play a protective role against RF, by encouraging bacteria elimination as well as increasing gene expression and protein levels. On the other hand, they may also predispose the patients to RHD symptoms, by probably contributing to chronic inflammation and tissue injury, thus emphasizing the dual importance of ficolin-1 in both conditions.
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Affiliation(s)
- Sandra Jeremias Catarino
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Fabiana Antunes Andrade
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Angelica Beate Winter Boldt
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
- Human Molecular Genetics Laboratory, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Iara Jose Messias-Reason
- Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
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8
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da Rocha LKA, Freschi de Barros S, Bandeira F, Bollini A, Testa LHDA, Simione AJ, Souza MDOE, Zanetti LP, de Oliveira LCS, Dos Santos ACF, de Souza MP, Colturado VAR, Kalil J, Machado CM, Guilherme L. Thymopoiesis in Pre- and Post-Hematopoietic Stem Cell Transplantation. Front Immunol 2018; 9:1889. [PMID: 30245685 PMCID: PMC6137257 DOI: 10.3389/fimmu.2018.01889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/28/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is an important therapeutic option for some hematological diseases. However, patients who undergo HSCT acquire a state of immunodeficiency that causes significant mortality. Reconstitution of thymic function is needed to support the immune system. One way to measure thymic function is through T-cell receptor excision circle (TREC) quantification. TRECs are generated by T-cell receptor gene rearrangements during T-cell maturation in the thymus and represent a reliable marker for thymic output. In this study, we aimed to assess aging and malignant hematological diseases as two important factors that may influence thymic output before HSCT. We observed that patients before HSCT presented signal joint TREC (sjTREC) numbers lower than 606.55 copies/μg DNA (low values) compared with healthy individuals, with an odds ratio (OR) of 12.88 [95% confidence interval (CI): 5.26–31.53; p < 0.001]. Our results showed that a group of older individuals (≥50 years old), comprising both healthy individuals and patients, had an OR of 10.07 (95% CI: 2.80–36.20) for low sjTREC values compared with younger individuals (≤24 years old; p < 0.001). Multiple logistic regression analysis confirmed that both older age (≥50 years old) and malignant hematological diseases and their treatments were important and independent risk factors related to thymic function impairment (p < 0.001). The median sjTREC value for patients of all ages was significantly lower than the sjTREC median for the subgroup of older healthy individuals (≥50 years old; p < 0.001). These data suggested that patients before HSCT and healthy individuals exhibited age-dependent thymic impairment, and that prior treatment for hematological diseases may exacerbate aging-related deterioration of natural thymic function. Furthermore, we analyzed these patients 9 months post-HSCT and compared patients who underwent autologous HSCT with those who underwent allogeneic HSCT. Both groups of patients achieved sjTREC copy numbers similar to those of healthy individuals. We did not find a close relationship between impaired thymic function prior to HSCT and worse thymic recovery after HSCT.
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Affiliation(s)
- Luis Klaus A da Rocha
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
| | - Samar Freschi de Barros
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
| | - Francine Bandeira
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | - Alexia Bollini
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | | | - Anderson João Simione
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | - Marina de O E Souza
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | - Lilian P Zanetti
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | | | | | - Mair Pedro de Souza
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | | | - Jorge Kalil
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
| | - Clarisse M Machado
- Laboratory of Virology, Tropical Medicine Institute (IMT), University of São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
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9
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Guilherme L, de Barros SF, Kohler K, Santos S, Ferreira FM, Silva W, Alencar R, Postol E, Kalil J. Rheumatic Heart Disease: Pathogenesis and Vaccine. Curr Protein Pept Sci 2018; 19:900-908. [DOI: 10.2174/1389203718666170725115855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Affiliation(s)
- L. Guilherme
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - S. Freschi de Barros
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - K.F. Kohler
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - S.R. Santos
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - F. Morais Ferreira
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - W.R. Silva
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - R. Alencar
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - E. Postol
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - J. Kalil
- Institute for Investigation in Immunology, Department of Clinical Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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10
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Abstract
Acute rheumatic fever is caused by an autoimmune response to throat infection with Streptococcus pyogenes. Cardiac involvement during acute rheumatic fever can result in rheumatic heart disease, which can cause heart failure and premature mortality. Poverty and household overcrowding are associated with an increased prevalence of acute rheumatic fever and rheumatic heart disease, both of which remain a public health problem in many low-income countries. Control efforts are hampered by the scarcity of accurate data on disease burden, and effective approaches to diagnosis, prevention, and treatment. The diagnosis of acute rheumatic fever is entirely clinical, without any laboratory gold standard, and no treatments have been shown to reduce progression to rheumatic heart disease. Prevention mainly relies on the prompt recognition and treatment of streptococcal pharyngitis, and avoidance of recurrent infection using long-term antibiotics. But evidence for the effectiveness of either approach is not strong. High-quality research is urgently needed to guide efforts to reduce acute rheumatic fever incidence and prevent progression to rheumatic heart disease.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, Institute for Investigation in Immunology, National Institute of Science and Technology, São Paulo, Brazil
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11
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Branco CEDB, Sampaio RO, Bracco MM, Morhy SS, Vieira MLC, Guilherme L, Rizzo LV, Tarasoutch F. Rheumatic Fever: a neglected and underdiagnosed disease. New perspective on diagnosis and prevention. Arq Bras Cardiol 2017; 107:482-484. [PMID: 27982273 PMCID: PMC5137393 DOI: 10.5935/abc.20160150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 08/08/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Mario Maia Bracco
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Centro de Estudos e Pesquisas Dr. João Amorim (CEJAM) - São Paulo, SP - Brazil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração - InCor, São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | | | | | - Flavio Tarasoutch
- Instituto do Coração - InCor, São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
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12
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Malmegrim KCR, de Azevedo JTC, Arruda LCM, Abreu JRF, Couri CEB, de Oliveira GLV, Palma PVB, Scortegagna GT, Stracieri ABPL, Moraes DA, Dias JBE, Pieroni F, Cunha R, Guilherme L, Santos NM, Foss MC, Covas DT, Burt RK, Simões BP, Voltarelli JC, Roep BO, Oliveira MC. Immunological Balance Is Associated with Clinical Outcome after Autologous Hematopoietic Stem Cell Transplantation in Type 1 Diabetes. Front Immunol 2017; 8:167. [PMID: 28275376 PMCID: PMC5319960 DOI: 10.3389/fimmu.2017.00167] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 10/20/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022] Open
Abstract
Autologous hematopoietic stem cell transplantation (AHSCT) increases C-peptide levels and induces insulin independence in patients with type 1 diabetes. This study aimed to investigate how clinical outcomes may associate with the immunological status, especially concerning the balance between immunoregulation and autoreactivity. Twenty-one type 1 diabetes patients were monitored after AHSCT and assessed every 6 months for duration of insulin independence, C-peptide levels, frequencies of islet-specific autoreactive CD8+ T cells (CTL), regulatory lymphocyte subsets, thymic function, and T-cell repertoire diversity. In median follow-up of 78 (range 15–106) months, all patients became insulin-independent, resuming insulin after median of 43 (range 6–100) months. Patients were retrospectively divided into short- or prolonged-remission groups, according to duration of insulin independence. For the entire follow-up, CD3+CD4+ T-cell numbers remained lower than baseline in both groups, whereas CD3+CD8+ T-cell levels did not change, resulting in a CD4/CD8 ratio inversion. Memory CTL comprehended most of T cells detected on long-term follow-up of patients after AHSCT. B cells reconstituted to baseline levels at 2–3 months post-AHSCT in both patient groups. In the prolonged-remission-group, baseline islet-specific T-cell autoreactivity persisted after transplantation, but regulatory T cell counts increased. Patients with lower frequencies of autoreactive islet-specific T cells remained insulin-free longer and presented greater C-peptide levels than those with lower frequencies of these cells. Therefore, immune monitoring identified a subgroup of patients with superior clinical outcome of AHSCT. Our study shows that improved immunoregulation may balance autoreactivity endorsing better metabolic outcomes in patients with lower frequencies of islet-specific T cells. Development of new strategies of AHSCT is necessary to increase frequency and function of T and B regulatory cells and decrease efficiently autoreactive islet-specific T and B memory cells in type 1 diabetes patients undergoing transplantation.
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Affiliation(s)
- Kelen C R Malmegrim
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Clinical, Toxicological and Bromatological Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Júlia T C de Azevedo
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas C M Arruda
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Joana R F Abreu
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center , Leiden , Netherlands
| | - Carlos E B Couri
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gislane L V de Oliveira
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Patricia V B Palma
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Gabriela T Scortegagna
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Ana B P L Stracieri
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Daniela A Moraes
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Juliana B E Dias
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Fabiano Pieroni
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Renato Cunha
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Nathália M Santos
- Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Milton C Foss
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Dimas T Covas
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Richard K Burt
- Division of Immunotherapy, Northwestern University Feinberg School of Medicine , Chicago, IL , USA
| | - Belinda P Simões
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Júlio C Voltarelli
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Bart O Roep
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands; Department of Diabetes Immunology, Diabetes & Metabolism Research Institute at City of Hope, Duarte, CA, USA
| | - Maria C Oliveira
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Martins CDO, Demarchi L, Ferreira FM, Pomerantzeff PMA, Brandao C, Sampaio RO, Spina GS, Kalil J, Cunha-Neto E, Guilherme L. Rheumatic Heart Disease and Myxomatous Degeneration: Differences and Similarities of Valve Damage Resulting from Autoimmune Reactions and Matrix Disorganization. PLoS One 2017; 12:e0170191. [PMID: 28121998 PMCID: PMC5266332 DOI: 10.1371/journal.pone.0170191] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022] Open
Abstract
Autoimmune inflammatory reactions leading to rheumatic fever (RF) and rheumatic heart disease (RHD) result from untreated Streptococcus pyogenes throat infections in individuals who exhibit genetic susceptibility. Immune effector mechanisms have been described that lead to heart tissue damage culminating in mitral and aortic valve dysfunctions. In myxomatous valve degeneration (MXD), the mitral valve is also damaged due to non-inflammatory mechanisms. Both diseases are characterized by structural valve disarray and a previous proteomic analysis of them has disclosed a distinct profile of matrix/structural proteins differentially expressed. Given their relevance in organizing valve tissue, we quantitatively evaluated the expression of vimentin, collagen VI, lumican, and vitronectin as well as performed immunohistochemical analysis of their distribution in valve tissue lesions of patients in both diseases. We identified abundant expression of two isoforms of vimentin (45 kDa, 42 kDa) with reduced expression of the full-size protein (54 kDa) in RHD valves. We also found increased vitronectin expression, reduced collagen VI expression and similar lumican expression between RHD and MXD valves. Immunohistochemical analysis indicated disrupted patterns of these proteins in myxomatous degeneration valves and disorganized distribution in rheumatic heart disease valves that correlated with clinical manifestations such as valve regurgitation or stenosis. Confocal microscopy analysis revealed a diverse pattern of distribution of collagen VI and lumican into RHD and MXD valves. Altogether, these results demonstrated distinct patterns of altered valve expression and tissue distribution/organization of structural/matrix proteins that play important pathophysiological roles in both valve diseases.
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Affiliation(s)
- Carlo de Oliveira Martins
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
- Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Lea Demarchi
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Frederico Moraes Ferreira
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
- Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Carlos Brandao
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Guilherme Sobreira Spina
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
- Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
- Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
- Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, São Paulo, Brazil
- * E-mail:
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Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, Sable C, Steer A, Wilson N, Wyber R, Zühlke L. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2:15084. [PMID: 27188830 PMCID: PMC5810582 DOI: 10.1038/nrdp.2015.84] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [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: 12/19/2022]
Abstract
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.
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Affiliation(s)
- Jonathan R Carapetis
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Andrea Beaton
- Children's National Health System, Washington, District of Columbia, USA
| | - Madeleine W Cunningham
- Department of Microbiology and Immunology, Biomedical Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute for Science and Technology, São Paulo, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Craig Sable
- Children's National Health System, Washington, District of Columbia, USA
| | - Andrew Steer
- Department of Paediatrics, the University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Hospital, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Rosemary Wyber
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Liesl Zühlke
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Paediatric Cardiology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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15
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Freschi de Barros S, De Amicis KM, Alencar R, Smeesters PR, Trunkel A, Postól E, Almeida Junior JN, Rossi F, Pignatari ACC, Kalil J, Guilherme L. Streptococcus pyogenes strains in Sao Paulo, Brazil: molecular characterization as a basis for StreptInCor coverage capacity analysis. BMC Infect Dis 2015; 15:308. [PMID: 26243278 PMCID: PMC4525746 DOI: 10.1186/s12879-015-1052-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/22/2015] [Indexed: 12/14/2022] Open
Abstract
Background Several human diseases are caused by Streptococcus pyogenes, ranging from common infections to autoimmunity. Characterization of the most prevalent strains worldwide is a useful tool for evaluating the coverage capacity of vaccines under development. In this study, a collection of S. pyogenes strains from Sao Paulo, Brazil, was analyzed to describe the diversity of strains and assess the vaccine coverage capacity of StreptInCor. Methods Molecular epidemiology of S. pyogenes strains was performed by emm-genotyping the 229 isolates from different clinical sites, and PCR was used for superantigen profile analysis. The emm-pattern and tissue tropism for these M types were also predicted and compared based on the emm-cluster classification. Results The strains were fit into 12 different emm-clusters, revealing a diverse phylogenetic origin and, consequently, different mechanisms of infection and escape of the host immune system. Forty-eight emm-types were distinguished in 229 samples, and the 10 most frequently observed types accounted for 69 % of all isolates, indicating a diverse profile of circulating strains comparable to other countries under development. A similar proportion of E and A-C emm-patterns were observed, whereas pattern D was less frequent, indicating that the strains of this collection primarily had a tissue tropism for the throat. In silico analysis of the coverage capacity of StreptInCor, an M protein-conserved regionally based vaccine candidate developed by our group, had a range of 94.5 % to 59.7 %, with a mean of 71.0 % identity between the vaccine antigen and the predicted amino acid sequence of the emm-types included here. Conclusions This is the first report of S. pyogenes strain characterization in Sao Paulo, one of the largest cities in the world; thus, the strain panel described here is a representative sample for vaccine coverage capacity analysis. Our results enabled evaluation of StreptInCor candidate vaccine coverage capacity against diverse M-types, indicating that the vaccine candidate likely would induce protection against the diverse strains worldwide.
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Affiliation(s)
- Samar Freschi de Barros
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Karine Marafigo De Amicis
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Raquel Alencar
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Pierre Robert Smeesters
- Laboratoire de Génétique et Physiologie Bactérienne, Institute de Biologie et de Médecine Moléculaires, Faculté des Sciences, Université Libre de Bruxelles, Bruxelles, 1050, Belgium. .,Murdoch Childrens Research Institute, Parkville, 3052, Australia.
| | - Ariel Trunkel
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Edilberto Postól
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - João Nóbrega Almeida Junior
- Microbiology Laboratory of Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | - Flavia Rossi
- Microbiology Laboratory of Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | | | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil. .,Clinical Immunology and Allergy Division, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil. .,Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil. .,Laboratory of Immunology, Clinical Hospital, Heart Institute (HC-FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
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16
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Guilherme L, Köhler KF, Faé KC. Editorial: Frontiers in Autoimmune Disease: Rheumatic Fever and Rheumatic Heart Disease. Front Pediatr 2015; 3:91. [PMID: 26579501 PMCID: PMC4623398 DOI: 10.3389/fped.2015.00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/14/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Luiza Guilherme
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Karen F Köhler
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Kellen C Faé
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
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17
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Martins CDO, Santos KS, Ferreira FM, Teixeira PC, Pomerantzeff PMA, Brandão CM, Sampaio RO, Spina GS, Kalil J, Guilherme L, Cunha-Neto E. Distinct mitral valve proteomic profiles in rheumatic heart disease and myxomatous degeneration. Clin Med Insights Cardiol 2014; 8:79-86. [PMID: 25232280 PMCID: PMC4159360 DOI: 10.4137/cmc.s17622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 01/18/2023]
Abstract
Rheumatic heart disease (RHD) affects heart-valve tissue and is the most serious consequence of group A Streptococcus infection. Myxomatous degeneration (MXD) is the most frequent valvopathy in the western world. In the present work, key protein expression alterations in the heart-valve tissue of RHD and MXD patients were identified and characterized, with controls from cadaveric organ donors. Proteins were separated by two-dimensional (2D)-electrophoresis and identified by mass spectrometry. We found 17 differentially expressed protein spots, as compared to control samples. We observed an increased expression of ASAP-2 in the RHD patients’ valves, while collagen-VI, haptoglobin-related protein, prolargin, and cartilage oligomeric protein showed reduced expression. Valve tissue of MXD patients, on the other hand, presented lower expression of annexin-A1 and A2, septin-2, SOD (Cu/Zn), and transgelin. Tissue samples from both valvopathies displayed higher expression of apolipoprotein-A1. Biglycan was downexpressed in both diseases. Vimentin and lumican showed higher expression in RHD and lower in MXD. These results suggest that key pathogenetic mechanisms are intrinsically distinct in RHD and MXD.
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Affiliation(s)
- Carlo de Oliveira Martins
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Keity Souza Santos
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Frederico Moraes Ferreira
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Priscila Camillo Teixeira
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Pharma Research and Early Development, F. Hoffmann-La Roche, Basel, Switzerland
| | | | - Carlos Ma Brandão
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Guilherme S Spina
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Heart Institute (INCOR), School of Medicine, University of São Paulo, São Paulo, Brazil. ; Institute of Investigation in Immunology, National Institute for Science and Technology, University of São Paulo, São Paulo, Brazil
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18
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Guilherme L, Postol E, Ferreira FM, DeMarchi LMF, Kalil J. StreptInCor: a model of anti-Streptococcus pyogenes vaccine reviewed. Auto Immun Highlights 2013; 4:81-5. [PMID: 26000146 PMCID: PMC4389027 DOI: 10.1007/s13317-013-0053-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 07/13/2013] [Indexed: 11/25/2022]
Abstract
Streptococcus pyogenes infections remain a health problem in multiple countries because of poststreptococcal sequelae, such as rheumatic fever and rheumatic heart disease. The epidemiological growth of streptococcal diseases in undeveloped and developing countries has encouraged many groups to study vaccine candidates for preventing group A streptococcus infections. We developed a vaccine epitope (StreptInCor) composed of 55 amino acid residues of the C-terminal portion of the M protein that encompasses both T and B cell protective epitopes. Using human blood samples, we showed that the StreptInCor epitope is recognized by individuals bearing different HLA class II molecules and could be considered a universal vaccine epitope. In addition, the StreptInCor molecular structure was solved by nuclear magnetic resonance spectroscopy, and a series of structural stability experiments was performed to elucidate its folding/unfolding mechanism. Using BALB-c and HLA class II transgenic mice, we evaluated the immune response over an extended period and found that StreptInCor was able to induce a robust immune response in both models. No cross-reaction was observed against cardiac proteins. The safety of the vaccine epitope was evaluated by analyzing histopathology, and no autoimmune or pathological reactions were observed in the heart or other organs. Vaccinated BALB/c mice challenged with a virulent strain of S. pyogenes had 100 % survival over 30 days. Taking all results into account, StreptInCor could be a safe and effective vaccine against streptococcus-induced disease.
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Affiliation(s)
- Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (HC-FMUSP), Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP 05403–903 Brazil
| | - Edilberto Postol
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Frederico Moraes Ferreira
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Lea M. F. DeMarchi
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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19
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Guilherme L, Kalil J. Rheumatic Heart Disease: Molecules Involved in Valve Tissue Inflammation Leading to the Autoimmune Process and Anti-S. pyogenes Vaccine. Front Immunol 2013; 4:352. [PMID: 24198818 PMCID: PMC3812567 DOI: 10.3389/fimmu.2013.00352] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 09/19/2013] [Accepted: 10/15/2013] [Indexed: 12/21/2022] Open
Abstract
The major events leading to both rheumatic fever (RF) and rheumatic heart disease (RHD) are reviewed. Several genes are involved in the development of RF and RHD. The inflammatory process that results from S. pyogenes infection involves the activation of several molecules such as VCAM and ICAM, which play a role in the migration of leukocytes to the heart, particularly to the valves. Specific chemokines, such as CXCL3/MIP1α as well as CCL1/I-309 and CXCL9/Mig, attract T cells to the myocardium and valves, respectively. The autoimmune reactions are mediated by both the B- and T-cell responses that begin at the periphery, followed by the migration of T cell clones to the heart and the infiltration of heart lesions in RHD patients. These cells recognize streptococcal antigens and human-tissue proteins. Molecular mimicry between streptococcal M protein and human proteins has been proposed as the triggering factor leading to autoimmunity in RF and RHD. The production of cytokines from peripheral and heart-infiltrating mononuclear cells suggests that T helper 1 and Th17 cytokines are the mediators of RHD heart lesions. The low numbers of IL-4 producing cells in the valvular tissue might contribute to the maintenance and progression of the valve lesions. The identification of a vaccine epitope opens a perspective of development of an effective and safe vaccine to prevent S. pyogenes infections, consequently RF and RHD.
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Affiliation(s)
- Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil ; Immunology Investigation Institute, National Institute for Science and Technology, University of São Paulo , São Paulo , Brazil
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De Amicis KM, Freschi de Barros S, Alencar RE, Postól E, Martins CDO, Arcuri HA, Goulart C, Kalil J, Guilherme L. Analysis of the coverage capacity of the StreptInCor candidate vaccine against Streptococcus pyogenes. Vaccine 2013; 32:4104-10. [PMID: 23994376 DOI: 10.1016/j.vaccine.2013.08.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/02/2013] [Accepted: 08/13/2013] [Indexed: 12/01/2022]
Abstract
Streptococcus pyogenes is responsible for infections as pharyngitis, sepsis, necrotizing fasciitis and streptococcal toxic shock syndrome. The M protein is the major bacterial antigen and consists of both polymorphic N-terminal portion and a conserved region. In the present study, we analyzed the in vitro ability of StreptInCor a C-terminal candidate vaccine against S. pyogenes to induce antibodies to neutralize/opsonize the most common S. pyogenes strains in Sao Paulo by examining the recognition by sera from StreptInCor immunized mice. We also evaluated the presence of cross-reactive antibodies against human heart valve tissue. Anti-StreptInCor antibodies were able to neutralize/opsonize at least 5 strains, showing that immunization with StreptInCor is effective against several S. pyogenes strains and can prevent infection and subsequent sequelae without causing autoimmune reactions.
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Affiliation(s)
- Karine M De Amicis
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil
| | - Samar Freschi de Barros
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil
| | - Raquel E Alencar
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil
| | - Edilberto Postól
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil
| | - Carlo de Oliveira Martins
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil
| | - Helen Andrade Arcuri
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Immunology Investigation Institute, National Institute for Science and Technology, University of Sao Paulo, Sao Paulo, Brazil.
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Postol E, Alencar R, Higa FT, Freschi de Barros S, Demarchi LMF, Kalil J, Guilherme L. StreptInCor: a candidate vaccine epitope against S. pyogenes infections induces protection in outbred mice. PLoS One 2013; 8:e60969. [PMID: 23593359 PMCID: PMC3620221 DOI: 10.1371/journal.pone.0060969] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/05/2013] [Indexed: 01/08/2023] Open
Abstract
Infection with Streptococcus pyogenes (S. pyogenes) can result in several diseases, particularly in children. S. pyogenes M protein is the major virulence factor, and certain regions of its N-terminus can trigger autoimmune sequelae such as rheumatic fever in susceptible individuals with untreated group A streptococcal pharyngitis. In a previous study, we utilized a large panel of human peripheral blood cells to define the C-terminal protective epitope StreptInCor (medical identity), which does not induce autoimmune reactions. We recently confirmed the results in HLA-transgenic mice. In the present study, we extended the experimental assays to outbred animals (Swiss mice). Herein, we demonstrate high titers of StreptInCor-specific antibodies, as well as appropriate T-cell immune responses. No cross-reaction to cardiac myosin was detected. Additionally, immunized Swiss mice exhibited 87% survival one month after challenge with S. pyogenes. In conclusion, the data presented herein reinforce previous results in humans and animals and further emphasize that StreptInCor could be an effective and safe vaccine for the prevention of S. pyogenes infections.
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Affiliation(s)
- Edilberto Postol
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Raquel Alencar
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Fabio T. Higa
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Samar Freschi de Barros
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Lea M. F. Demarchi
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
- * E-mail:
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Guilherme L, Ferreira FM, Köhler KF, Postol E, Kalil J. A vaccine against Streptococcus pyogenes: the potential to prevent rheumatic fever and rheumatic heart disease. Am J Cardiovasc Drugs 2013; 13:1-4. [PMID: 23355360 DOI: 10.1007/s40256-013-0005-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Streptococcus pyogenes causes severe, invasive infections such as the sequelae associated with acute rheumatic fever, rheumatic heart disease, acute glomerulonephritis, uncomplicated pharyngitis, and pyoderma. Efforts to produce a vaccine against S. pyogenes began several decades ago, and different models have been proposed. We have developed a vaccine candidate peptide, StreptInCor, comprising 55 amino acid residues of the C-terminal portion of the M protein and encompassing both the T- and B-cell protective epitopes. The present article summarizes data from the previous 5 years during which we tested the immunogenicity and safety of StreptInCor in different animal models. We showed that StreptInCor overlapping peptides induced cellular and humoral immune responses of individuals bearing different HLA class II molecules. These results are consistent with peptides that have a universal vaccine epitope. The tridimensional molecular structure of StreptInCor was elucidated by nuclear magnetic resonance spectroscopy, which showed that its structure is composed of two microdomains linked by an 18-residue α-helix. Additionally, we comprehensively evaluated the structural stability of the StreptInCor peptide in different physicochemical conditions using circular dichroism. Additional experiments were performed with inbred, outbred, and HLA class II transgenic mice. Analysis of several organs of these mice showed neither deleterious nor autoimmune reactions even after a long period of vaccination, indicating that the StreptInCor candidate peptide could be considered as an immunogenic and safe vaccine.
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Cappi C, Muniz RK, Sampaio AS, Cordeiro Q, Brentani H, Palácios SA, Marques AH, Vallada H, Miguel EC, Guilherme L, Hounie AG. Association study between functional polymorphisms in the TNF-alpha gene and obsessive-compulsive disorder. Arq Neuropsiquiatr 2012; 70:87-90. [PMID: 22311210 DOI: 10.1590/s0004-282x2012000200003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 10/07/2011] [Indexed: 01/28/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder of unknown etiology. However, there is some evidence that the immune system may play an important role in its pathogenesis. In the present study, two polymorphisms (rs1800795 and rs361525) in the promoter region of the cytokine tumor necrosis factor-alpha (TNFA) gene were genotyped in 183 OCD patients and in 249 healthy controls. The statistical tests were performed using the PLINK(®) software. We found that the A allele of the TNFA rs361525 polymorphism was significantly associated with OCD subjects, according to the allelic χ(2) association test (p=0.007). The presence of genetic markers, such as inflammatory cytokines genes linked to OCD, may represent additional evidence supporting the role of the immune system in its pathogenesis.
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Affiliation(s)
- Carolina Cappi
- Department of Psychiatry, Medical School, University of São Paulo, Brazil
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Lezirovitz K, Batissoco AC, Lima FT, Auricchio MTBM, Nonose RW, dos Santos SR, Guilherme L, Oiticica J, Mingroni-Netto RC. Aberrant transcript produced by a splice donor site deletion in the TECTA gene is associated with autosomal dominant deafness in a Brazilian family. Gene 2012; 511:280-4. [PMID: 22995349 DOI: 10.1016/j.gene.2012.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/28/2012] [Accepted: 09/06/2012] [Indexed: 01/22/2023]
Abstract
We ascertained a Brazilian family with nine individuals affected by autosomal dominant nonsyndromic sensorineural hearing loss. The bilateral hearing loss affected mainly mid-high frequencies, was apparently stable with an early onset. Microsatellites close to the DFNA8/DFNA12 locus, which harbors the TECTA gene, showed significant multipoint lod scores (3.2) close to marker D11S4107. Sequencing of the exons and exon-intron boundaries of the TECTA gene in one affected subject revealed the deletion c.5383+5delGTGA in the 5' end of intron 16, that includes the last two bases of the donor splice site consensus sequence. This mutation segregates with deafness within the family. To date, 33 different TECTA mutations associated with autossomal dominant hearing loss have been described. Among them is the mutation reported herein, first described by Hildebrand et al. (2011) in a UK family. The audioprofiles from the UK and Brazilian families were similar. In order to investigate the transcripts produced by the mutated allele, we performed cDNA analysis of a lymphoblastoid cell line from an affected heterozygote with the c.5383+5delGTGA and a noncarrier from the same family. The analysis allowed us to identify an aberrant transcript with skipping of exon 16, without affecting the reading frame. One of the dominant TECTA mutations already described, a synonymous substitution in exon 16 (c.5331G<A), was also shown to affect splicing, resulting in an aberrant transcript lacking exon 16. Despite the difference in the DNA level, both the synonymous substitution in exon 16 (c.5331G<A) and the mutation described herein affect splicing of exon 16, leading to its skipping. At the protein level they would have the same effect, an in-frame deletion of 37 amino-acids (p.S1758Y/G1759_N1795del) probably leading to an impaired function of the ZP domain. Thus, like the TECTA missense mutations associated with dominant hearing loss, the c.5383+5delGTGA mutation does not have an inactivating effect on the protein.
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Affiliation(s)
- Karina Lezirovitz
- Human Genome Research Center, Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo (SP), Brazil.
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Abstract
Through a comprehensive review of the recent findings on rheumatic fever, we intend to propose a new physiopathologic model for this disease. A Medline search was performed for all articles containing the terms rheumatic fever or rheumatic heart disease in title or abstract from 1970 to 2011. Best evidence qualitative technique was used to select the most relevant. The scientific interest on rheumatic fever has notably diminished throughout the twentieth century as evidenced by the comparison of the proportion of articles in which RF was a subject in 1950 (0.26%) and today (0.03%) [Pubmed]. However, RF remains a major medical and social problem in the developing world and in the so-called hotspots, where it still causes around 500.000 deaths each year, not too different from the pre-antibiotic era. The role of genetic factors in RF susceptibility is discussed. Familiar aggregation, similarity of disease patterns between siblings, identical twin, and HLA correlation studies are evidence for a genetic influence on RF susceptibility. The suspect-involved genes fall mainly into those capable of immunologic mediation. Molecular mimicry explains the triggering of RF, but an intense and sustained inflammation is needed to cause sequels. Also, RF patients vary greatly in terms of symptoms. It is likely that a genetic background directing immune response towards a predominantly Th1 or Th2 pattern contributes to these features. The recent findings on rheumatic fever provide important insight on its physiopathology that helps understanding this prototype post-infectious autoimmune disease giving insights on other autoimmune conditions.
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Guerino MT, Postol E, Demarchi LMF, Martins CO, Mundel LR, Kalil J, Guilherme L. HLA class II transgenic mice develop a safe and long lasting immune response against StreptInCor, an anti-group A streptococcus vaccine candidate. Vaccine 2011; 29:8250-6. [PMID: 21907752 DOI: 10.1016/j.vaccine.2011.08.113] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/24/2011] [Accepted: 08/28/2011] [Indexed: 11/19/2022]
Abstract
Streptococcus pyogenes infections remain a health problem in several countries because of post-streptococcal sequelae, such as rheumatic fever and rheumatic heart disease. We developed a vaccine epitope (StreptInCor) composed of 55 amino acid residues of the C-terminal portion of the M protein that encompasses both T and B cell protective epitopes. Recently, by using human blood samples, we showed that the StreptInCor epitope is able to bind to different HLA class II molecules and that it could be considered a universal vaccine epitope. In the present work, we evaluated the immune response of HLA class II transgenic mice against aluminum hydroxide-absorbed StreptInCor. After a period of one year, several organs were analyzed histologically to verify the safety of the candidate vaccine epitope. Our results showed that StreptInCor is able to induce robust and safe and long lasting immune response without deleterious reactions in several organs. In conclusion, the results presented here indicate that StreptInCor could be considered a safe vaccine against severe streptococcus-induced diseases.
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Abstract
Pathogenesis of rheumatic heart disease (RHD) remains incompletely understood. Several genes associated with RHD have been described; most of these are involved with immune responses. Single nucleotide polymorphisms in a number of genes affect patients with RHD compared to controls. Molecular mimicry between streptococcal antigens and human proteins, including cardiac myosin epitopes, vimentin and other intracellular proteins is central to the pathogenesis of RHD. Autoreactive T cells migrate from the peripheral blood to the heart and proliferate in the valves in response to stimulation with specific cytokines. The types of cells involved in the inflammation as well as different cytokine profiles in these patients are being investigated. High TNF alpha, interferon gamma, and low IL4 are found in the rheumatic valve suggesting an imbalance between Th1 and Th2 cytokines and probably contributing to the progressive and permanent valve damage. Animal model of ARF in the Lewis rat may further contribute towards understanding the ARF.
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Affiliation(s)
- L Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo; Brazil
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Guilherme L, Alba MP, Ferreira FM, Oshiro SE, Higa F, Patarroyo ME, Kalil J. Anti-group A streptococcal vaccine epitope: structure, stability, and its ability to interact with HLA class II molecules. J Biol Chem 2011; 286:6989-98. [PMID: 21169359 PMCID: PMC3044955 DOI: 10.1074/jbc.m110.132118] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 09/01/2010] [Indexed: 12/29/2022] Open
Abstract
Streptococcus pyogenes infections remain a health problem in several countries due to poststreptococcal sequelae. We developed a vaccine epitope (StreptInCor) composed of 55 amino acids residues of the C-terminal portion of the M protein that encompasses both T and B cell protective epitopes. The nuclear magnetic resonance (NMR) structure of the StreptInCor peptide showed that the structure was composed of two microdomains linked by an 18-residue α-helix. A chemical stability study of the StreptInCor folding/unfolding process using far-UV circular dichroism showed that the structure was chemically stable with respect to pH and the concentration of urea. The T cell epitope is located in the first microdomain and encompasses 11 out of the 18 α-helix residues, whereas the B cell epitope is in the second microdomain and showed no α-helical structure. The prediction of StreptInCor epitope binding to different HLA class II molecules was evaluated based on an analysis of the 55 residues and the theoretical possibilities for the processed peptides to fit into the P1, P4, P6, and P9 pockets in the groove of several HLA class II molecules. We observed 7 potential sites along the amino acid sequence of StreptInCor that were capable of recognizing HLA class II molecules (DRB1*, DRB3*, DRB4*, and DRB5*). StreptInCor-overlapping peptides induced cellular and humoral immune responses of individuals bearing different HLA class II molecules and could be considered as a universal vaccine epitope.
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Affiliation(s)
- Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, São Paulo 5403-903, Brazil.
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Guilherme L, Köhler KF, Kalil J. Rheumatic heart disease: mediation by complex immune events. Adv Clin Chem 2011; 53:31-50. [PMID: 21404913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Rheumatic fever (RF) is an autoimmune disease caused by the Gram-positive bacteria Streptococcus pyogenes following an untreated throat infection in susceptible children. Rheumatic heart disease (RHD), the most serious complication, occurs in 30-45% of RF patients and leads to chronic valvular lesions. Here, we focus on the genes that confer susceptibility for developing this disease. Molecular mimicry mediates the cross-reactions between streptococcal antigens and human proteins. Several autoantigens have been identified, including cardiac myosin epitopes, vimentin, and other intracellular proteins. In heart tissue, antigen-driven oligoclonal T cell expansions probably cause the rheumatic heart lesions. These cells are CD4+ and produce inflammatory cytokines (TNF alpha and IFN gamma). IL-4+ cells are found in the myocardium; however, these cells are very scarce in the valve lesions of RHD patients. IL-4 is a Th2-type cytokine and plays a regulatory role in the inflammatory response mediated by Th1 cytokines. Our findings indicate that the Th1/Th2 cytokine balance has a role in healing myocarditis while the low numbers of IL-4-producing cells in the valves probably induced the progressive and permanent valve damage.
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Affiliation(s)
- L Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
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Cordeiro Q, Cappi C, Sampaio AS, Palácios SA, Pereira CADB, Shavitt RG, Miguel EC, Guilherme L, Hounie AG. Association study between the -62A/T NFKBIL1 polymorphism and obsessive-compulsive disorder. Braz J Psychiatry 2010; 31:131-5. [PMID: 19578685 DOI: 10.1590/s1516-44462009000200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 02/05/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evidence from family and molecular genetic studies support the hypothesis of involvement of immunologic mechanisms in the pathophysiology of obsessive-compulsive disorder. The nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor-like 1 (NFKBIL1) has been suggested as a modulator of the immunological system. Given the importance of NFKBIL1 in the immunological response, the present study investigated the -62A/T polymorphism (rs2071592), located in the promoter region of its gene (NFKBIL1), as a genetic risk factor for the development of obsessive-compulsive disorder. METHOD The -62A/T NFKBIL1 polymorphism was investigated in a sample of 111 patients who met DSM-IV criteria for obsessive-compulsive disorder and 272 healthy age- and gender-matched controls. RESULTS There were no differences in genotypic distributions between patients and controls (chi2 = 0.98; 2 d.f.; p = 0.61). DISCUSSION Despite these negative findings, more comprehensive polymorphism coverage within the NFKBIL1 is warranted in larger samples. Populations with different ethnic backgrounds should also be studied. CONCLUSION The results of the present investigation do not provide evidence for the association between the -62A/T NFKBIL1 polymorphism and obsessive-compulsive disorder in this Brazilian sample.
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Affiliation(s)
- Quirino Cordeiro
- Department and Institute of Psychiatry, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
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Ribeiro SP, Rosa DS, Fonseca SG, Mairena EC, Postól E, Oliveira SC, Guilherme L, Kalil J, Cunha-Neto E. A vaccine encoding conserved promiscuous HIV CD4 epitopes induces broad T cell responses in mice transgenic to multiple common HLA class II molecules. PLoS One 2010; 5:e11072. [PMID: 20552033 PMCID: PMC2884037 DOI: 10.1371/journal.pone.0011072] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 05/19/2010] [Indexed: 11/19/2022] Open
Abstract
Current HIV vaccine approaches are focused on immunogens encoding whole HIV antigenic proteins that mainly elicit cytotoxic CD8+ responses. Mounting evidence points toward a critical role for CD4+ T cells in the control of immunodeficiency virus replication, probably due to cognate help. Vaccine-induced CD4+ T cell responses might, therefore, have a protective effect in HIV replication. In addition, successful vaccines may have to elicit responses to multiple epitopes in a high proportion of vaccinees, to match the highly variable circulating strains of HIV. Using rational vaccine design, we developed a DNA vaccine encoding 18 algorithm-selected conserved, “promiscuous” (multiple HLA-DR-binding) B-subtype HIV CD4 epitopes - previously found to be frequently recognized by HIV-infected patients. We assessed the ability of the vaccine to induce broad T cell responses in the context of multiple HLA class II molecules using different strains of HLA class II- transgenic mice (-DR2, -DR4, -DQ6 and -DQ8). Mice displayed CD4+ and CD8+ T cell responses of significant breadth and magnitude, and 16 out of the 18 encoded epitopes were recognized. By virtue of inducing broad responses against conserved CD4+ T cell epitopes that can be recognized in the context of widely diverse, common HLA class II alleles, this vaccine concept may cope both with HIV genetic variability and increased population coverage. The vaccine may thus be a source of cognate help for HIV-specific CD8+ T cells elicited by conventional immunogens, in a wide proportion of vaccinees.
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Affiliation(s)
- Susan Pereira Ribeiro
- Laboratory of Clinical Immunology and Allergy-LIM60, Division of Clinical Immunology and Allergy, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
| | - Daniela Santoro Rosa
- Laboratory of Clinical Immunology and Allergy-LIM60, Division of Clinical Immunology and Allergy, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
| | - Simone Gonçalves Fonseca
- Laboratory of Clinical Immunology and Allergy-LIM60, Division of Clinical Immunology and Allergy, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Eliane Conti Mairena
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
| | - Edilberto Postól
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
| | - Sergio Costa Oliveira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Clinical Immunology and Allergy-LIM60, Division of Clinical Immunology and Allergy, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Clinical Immunology and Allergy-LIM60, Division of Clinical Immunology and Allergy, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology-INCT, São Paulo, Brazil
- * E-mail:
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Faé KC, Diefenbach da Silva D, Bilate AMB, Tanaka AC, Pomerantzeff PMA, Kiss MH, Silva CAA, Cunha-Neto E, Kalil J, Guilherme L. PDIA3, HSPA5 and vimentin, proteins identified by 2-DE in the valvular tissue, are the target antigens of peripheral and heart infiltrating T cells from chronic rheumatic heart disease patients. J Autoimmun 2008; 31:136-41. [PMID: 18541406 DOI: 10.1016/j.jaut.2008.04.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 12/11/2022]
Abstract
Rheumatic fever (RF) is a post-infectious autoimmune disease due to sequel of group A streptococcus (GAS) pharyngitis. Rheumatic heart disease (RHD), the major manifestation of RF, is characterized by inflammation of heart valves and myocardium. Molecular mimicry between GAS antigens and host proteins has been shown at B and T cell level. However the identification of the autoantigens recognized by B and T cells within the inflammatory microenvironment of heart tissue in patients with RHD is still incompletely elucidated. In the present study, we used two-dimensional gel electrophoresis (2-DE) and mass spectrometry to identify valvular tissue proteins target of T cells from chronic RHD patients. We could identify three proteins recognized by heart infiltrating and peripheral T cells as protein disulfide isomerase ER-60 precursor (PDIA3), 78kD glucose-regulated protein precursor (HSPA5) and vimentin, with coverage of 45%, 43 and 34%, respectively. These proteins were recognized in a proliferation assay by peripheral and heart infiltrating T cells from RHD patients suggesting that they may be involved in the autoimmune reactions that leads to valve damage. We also observed that several other proteins isolated by 2-DE but not identified by mass spectrometry were also recognized by T cells. The identified cardiac proteins are likely relevant antigens involved in T cell-mediated autoimmune responses in RF/RHD that may contribute to the development of RHD.
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Affiliation(s)
- Kellen C Faé
- Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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Kuribayashi JS, Bombardieri CR, Baracho GV, Aliberti J, Machado FS, Kalil J, Guilherme L, Kokron CM, Rizzo LV, de Camargo MM. Slower rescue of ER homeostasis by the unfolded protein response pathway associated with common variable immunodeficiency. Mol Immunol 2008; 45:2990-7. [PMID: 18325593 DOI: 10.1016/j.molimm.2008.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 01/11/2008] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
Abstract
Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by hypogammaglobulinemia and recurrent infections. Herein we addressed the role of unfolded protein response (UPR) in the pathogenesis of the disease. Augmented unspliced X-box binding protein 1 (XBP-1) mRNA concurrent with co-localization of IgM and BiP/GRP78 were found in one CVID patient. At confocal microscopy analysis this patient's cells were enlarged and failed to present the typical surface distribution of IgM, which accumulated within an abnormally expanded endoplasmic reticulum. Sequencing did not reveal any mutation on XBP-1, neither on IRE-1alpha that could potentially prevent the splicing to occur. Analysis of spliced XBP-1, IRE-1alpha and BiP messages after LPS or Brefeldin A treatment showed that, unlike healthy controls that respond to these endoplasmic reticulum (ER) stressors by presenting waves of transcription of these three genes, this patient's cells presented lower rates of transcription, not reaching the same level of response of healthy subjects even after 48 h of ER stress. Treatment with DMSO rescued IgM and IgG secretion as well as the expression of spliced XBP-1. Our findings associate diminished splicing of XBP-1 mRNA with accumulation of IgM within the ER and lower rates of chaperone transcription, therefore providing a mechanism to explain the observed hypogammaglobulinemia.
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Affiliation(s)
- Juliana S Kuribayashi
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Avenida Professor Lineu Prestes 1730, São Paulo, Brazil
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Sampaio RO, Fae KC, Demarchi LMF, Pomerantzeff PMA, Aiello VD, Spina GS, Tanaka AC, Oshiro SE, Grinberg M, Kalil J, Guilherme L. Rheumatic heart disease: 15 years of clinical and immunological follow-up. Vasc Health Risk Manag 2008; 3:1007-17. [PMID: 18200819 PMCID: PMC2350126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Rheumatic fever (RF) is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD), the major sequel of RF, occurs in 30%-45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximately 90% of early childhood valvular surgery in the country. In this study, we present a 15-year clinical follow-up of 25 children who underwent surgical valvular repair. Histopathological and immunological features of heart tissue lesions of RHD patients were also evaluated. The patients presented severe forms of RHD with congestive symptoms at a very young age. Many of them had surgery at the acute phase of RF. Histological analysis showed the presence of dense valvular inflammatory infiltrates and Aschoff nodules in the myocardium of 21% of acute RHD patients. Infiltrating T-cells were mainly CD4+ in heart tissue biopsies of patients with rheumatic activity. In addition, CD4+ and CD8+ infiltrating T-cell clones recognized streptococcal M peptides and cardiac tissue proteins. These findings may open the possibilities of new ways of immunotherapy. In addition, we demonstrated that the surgical procedure during acute phase of the disease improved the quality of life of young RHD patients.
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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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Affiliation(s)
- Luiza Guilherme
- Heart Institute-InCor, University of São Paulo, School of Medicine, São Paulo, Brazil
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Girschick HJ, Guilherme L, Inman RD, Latsch K, Rihl M, Sherer Y, Shoenfeld Y, Zeidler H, Arienti S, Doria A. Bacterial triggers and autoimmune rheumatic diseases. Clin Exp Rheumatol 2008; 26:S12-S17. [PMID: 18570749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Autoimmune rheumatic diseases are generally considered as a multifactorial aetiology, mainly genetic susceptibility combined with environmental triggers of which bacteria are considered one of the most prominent. Among the rheumatic diseases where bacterial agents are more clearly involved as triggers are: reactive arthritis (ReA), rheumatic fever (RF) and Lyme disease. The role of bacterial infections in inducing other seronegative spondyloarthritis and antiphospholipid antibody syndrome has been hypothesized but is still not proven. The classic form of ReA is associated with the presence of HLA-B27 and is triggered by the urethritis or enteritis causing pathogens Chlamydia trachomatis and the enterobacteria Salmonella, Shigella, and Yersinia, respectively. But several other pathogens such as Brucella, Leptospira, Mycobacteria, Neisseria, Staphylococcus and Streptococcus have also been reported to cause ReA. RF is due to an autoimmune reaction triggered by an untreated throat infection by Streptococcus pyogenes in susceptible individuals. Carditis is the most serious manifestation of RF and HLA-DR7 is predominantly observed in the development of valvular lesions. Lyme disease is a tick-transmitted disease caused by the spirochete Borrelia burgdorferi. Knowledge is limited about how this spirochete interacts with human tissues and cells. Some data report that Borrelia burgdorferi can manipulate resident cells towards a pro- but also anti-inflammatory reaction and persist over a long period of time inside the human body or even inside human cells.
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Affiliation(s)
- H J Girschick
- Pediatric Rheumatology, Immunology, Infectious Diseases, Children's Hospital, University of Wuerzburg, Germany
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Fae KC, Palacios S, Tanaka A, Pomerantzeff P, Kalil J, Guilherme L. Sa.15. CCL3/MIP1-alpha and CCL1/I-309 are the Mediators of Cellular Infiltration of Myocardium and Vavular Heart Lesions in Severe Rheumatic Carditis Patients. Clin Immunol 2008. [DOI: 10.1016/j.clim.2008.03.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Rheumatic fever (RF) is triggered by S. pyogenes and affects 3-4% of untreated susceptible children. The immune response against streptococcal antigens can lead cross-recognition of heart tissue proteins resulting in rheumatic heart disease (RHD). HLA class II alleles have been associated with the development of RF/RHD. Tumor necrosis factor (TNF)-alpha is also located in the same chromosomal region of HLA genes and has been investigated in RHD patients from Mexico, Turkey, and Brazil. Associations with the TNFA-308 allele were found and probably are related to the development of valvular lesions. A deficient mannose-binding lectin (MBL) allele was found in Brazilian patients. MBL is a protein important for the first line of host defense against the bacteria. The association with diverse genes probably indicates a role of certain molecules in both the innate and adaptive immune response. Antigen-presenting cells bearing the HLA-DR7 molecule from RHD patients preferentially recognized a heart-tissue protein cross-reactive M5 (81-96) peptide. The same peptide was also recognized by heart tissue T cell clones. Cardiac myosin peptides were recognized by high numbers of intralesional T cell clones. The cytokine pattern of infiltrating mononuclear cells in both myocardium and valvular tissue showed a predominance of proinflammatory cytokines (TNF-alpha and IFN-gamma) and scarce production of regulatory cytokines, such as IL-4, in the valve tissue. IL-10, a predominant regulatory cytokine, was also secreted by large numbers of cells in both valve and myocardium tissue. Data here indicate the complexity of immune reactions leading to autoimmune lesions in RF/RHD.
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Affiliation(s)
- L Guilherme
- Heart Institute (InCor), School of Medicine, Univaersity of São Paulo, São Paulo, Brazil.
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41
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Abstract
Molecular mimicry between streptococcal and human proteins is considered as the triggering factor leading to autoimmunity in rheumatic fever (RF) and rheumatic heart disease (RHD). Here, we present a review of the genetic susceptibility markers involved in the development of RF/RHD and the major immunopathological events underlying the pathogenesis of RF and RHD. Several human leucocyte antigen (HLA) class II alleles are associated with the disease. Among these alleles, HLA-DR7 is predominantly observed in different ethnicities and is associated with the development of valvular lesions in RHD patients. Cardiac myosin is one of the major autoantigens involved in rheumatic heart lesions and several peptides from the LMM (light meromyosin) region were recognized by peripheral and intralesional T-cell clones from RF and RHD patients. The production of TNF-alpha and IFN-gamma from heart-infiltrating mononuclear cells suggests that Th-1 type cytokines are the mediators of RHD heart lesions while the presence of few interleukin-4 producing cells in the valve tissue contributes to the maintenance and progression of the valvular lesions.
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Affiliation(s)
- L Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
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Fonseca SG, Reis MM, Coelho V, Nogueira LG, Monteiro SM, Mairena EC, Bacal F, Bocchi E, Guilherme L, Zheng XX, Liew FY, Higuchi ML, Kalil J, Cunha-Neto E. Locally produced survival cytokines IL-15 and IL-7 may be associated to the predominance of CD8+ T cells at heart lesions of human chronic Chagas disease cardiomyopathy. Scand J Immunol 2007; 66:362-71. [PMID: 17635814 DOI: 10.1111/j.1365-3083.2007.01987.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human chronic Chagas disease cardiomyopathy (CCC) is an inflammatory-dilated cardiomyopathy occurring years after infection by the protozoan Trypanosoma cruzi. The heart inflammatory infiltrate in CCC shows a 2:1 predominance of CD8(+) in relation to CD4(+) T cells, with a typical Th1-type cytokine profile. However, in vitro expansion of infiltrating T cells from heart biopsy-derived fragments with interleukin-2 (IL-2) and phytohaemagglutinin leads to the outgrowth of CD4(+) over CD8(+) T cells. We hypothesized that survival cytokines, such as IL-2, IL-7 and IL-15 might be differentially involved in the growth and maintenance of heart-infiltrating and peripheral CD8(+) T cells from CCC patients. We found that IL-7 and IL-15 were superior to IL-2 in the expansion and viability of CD8(+) T cells from both PBMC and heart-infiltrating T-cell lines from CCC patients, and the combination of the three cytokines showed synergic effects. Heart-infiltrating CD8(+) T cells showed higher expression of both IL-15R alpha and gamma(c) chain than CD4(+) T cells, which may explain the improvement of CD8(+) T-cell growth in the presence of IL-2 + IL-7 + IL-15. Immunohistochemical identification of IL-15 and the higher mRNA expression of IL-15R alpha, IL-7 and gamma(c) chain in CCC heart tissues compared with control individuals indicate in situ production of survival cytokines and their receptors in CCC hearts. Together, our results suggest that local production of IL-7 and IL-15 may be associated with the maintenance and predominance of CD8(+) T cells, the cells effecting tissue damage in CCC hearts.
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Affiliation(s)
- S G Fonseca
- Laboratory of Immunology, Heart Institute of the Sao Paulo University Medical School, Sao Paulo, Brazil
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Cohon A, Arruda LK, Martins MA, Guilherme L, Kalil J. Evaluation of BCG administration as an adjuvant to specific immunotherapy in asthmatic children with mite allergy. J Allergy Clin Immunol 2007; 120:210-3. [PMID: 17531299 DOI: 10.1016/j.jaci.2007.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/05/2007] [Accepted: 04/09/2007] [Indexed: 11/19/2022]
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Guilherme L, Faé KC, Oshiro SE, Tanaka AC, Pomerantzeff PMA, Kalil J. T cell response in rheumatic fever: crossreactivity between streptococcal M protein peptides and heart tissue proteins. Curr Protein Pept Sci 2007; 8:39-44. [PMID: 17305559 DOI: 10.2174/138920307779941488] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/22/2022]
Abstract
Molecular mimicry between streptococcal and human proteins has been proposed as the triggering factor leading to autoimmunity in rheumatic fever (RF) and rheumatic heart disease (RHD). In this review we focus on the studies on genetic susceptibility markers involved in the development of RF/RHD and molecular mimicry mediated by T cell responses of RHD patients against streptococcal antigens and human tissue proteins. We identified several M protein epitopes recognized by peripheral T cells of RF/RHD patients and by heart tissue infiltrating T cell clones of severe RHD patients. The regions of the M protein preferentially recognized by human T cells were also recognized by murine T cells. By analyzing the T cell receptor (TCR) we observed that some Vbeta families detected on the periphery were oligoclonal expanded in the heart lesions. These results allowed us to confirm the major role of T cells in the development of RHD lesions.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Bacterial/biosynthesis
- Antigens, Bacterial/genetics
- Antigens, Bacterial/immunology
- Autoantibodies/biosynthesis
- Bacterial Outer Membrane Proteins/genetics
- Bacterial Outer Membrane Proteins/immunology
- Carrier Proteins/genetics
- Carrier Proteins/immunology
- Cross Reactions
- Genetic Predisposition to Disease
- Humans
- Immunity, Cellular
- Mice
- Molecular Mimicry
- Molecular Sequence Data
- Myocardium/immunology
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Rheumatic Fever/genetics
- Rheumatic Fever/immunology
- Rheumatic Fever/microbiology
- Streptococcus pyogenes/genetics
- Streptococcus pyogenes/immunology
- Streptococcus pyogenes/pathogenicity
- T-Lymphocytes/immunology
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Affiliation(s)
- Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
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45
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Guilherme L, Faé KC, Higa F, Chaves L, Oshiro SE, Freschi de Barros S, Puschel C, Juliano MA, Tanaka AC, Spina G, Kalil J. Towards a vaccine against rheumatic fever. Clin Dev Immunol 2007; 13:125-32. [PMID: 17162355 PMCID: PMC2270766 DOI: 10.1080/17402520600877026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Rheumatic fever (RF) is an autoimmune disease which affects more than 20 million children in developing countries. It is triggered by Streptococcus pyogenes throat infection in untreated susceptible individuals. Carditis, the most serious manifestation of the disease, leads to severe and permanent valvular lesions, causing chronic rheumatic heart disease (RHD). We have been studying the mechanisms leading to pathological autoimmunity in RF/RHD for the last 15 years. Our studies allowed us a better understanding of the cellular and molecular pathogenesis of RHD, paving the way for the development of a safe vaccine for a post-infection autoimmune disease. We have focused on the search for protective T and B cell epitopes by testing 620 human blood samples against overlapping peptides spanning 99 residues of the C-terminal portion of the M protein, differing by one amino acid residue. We identified T and B cell epitopes with 22 and 25 amino acid residues, respectively. Although these epitopes were from different regions of the C-terminal portion of the M protein, they showed an identical core of 16 amino acid residues. Antibodies against the B cell epitope inhibited bacterial invasion/adhesion in vitro. Our results strongly indicated that the selected T and B cell epitopes could potentially be protective against S. pyogenes.
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Affiliation(s)
- L Guilherme
- School of Medicine, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.
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46
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Hounie AG, Pauls DL, do Rosario-Campos MC, Mercadante MT, Diniz JB, De Mathis MA, De Mathis ME, Chacon P, Shavitt RG, Curi M, Guilherme L, Miguel EC. Obsessive-compulsive spectrum disorders and rheumatic fever: a family study. Biol Psychiatry 2007; 61:266-72. [PMID: 16616727 DOI: 10.1016/j.biopsych.2006.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 01/30/2006] [Accepted: 02/06/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obsessive-compulsive spectrum disorders (OCSDs) are more frequent in patients with active or prior rheumatic fever (RF), suggesting that OCSD and RF may share underlying etiologic mechanisms. Our objective was to estimate the frequency of OCSD in first-degree relatives (FDRs) of RF patients and controls to determine whether there is a familial relationship between OCSD and RF. METHODS This is a case-control family study. Of the 98 probands included in this study, 31 had RF without Sydenham's chorea (SC) and had 131 relatives, 28 had RF with SC and had 120 relatives, and 39 were controls without RF. All probands, 87.9% of the RF FDRs and 93.7% of the control FDRs were assessed directly with structured psychiatric interviews and best-estimate diagnoses were assigned. Odds ratios of morbid risks were estimated using logistic regression by the generalized estimating equations (GEE) method and compared between groups. RESULTS The rate of OCSDs was significantly higher among FDRs of RF probands than among FDRs of controls (n=37; 14.7% vs. n=10; 7.3%, i=.0279). A diagnosis of OCSDs in an RF proband was associated with a higher rate of OCSDs among FDRs when compared to control FDRs (p-GEE=.02). There was a trend for a higher rate of OCSDs among FDRs of RF probands presenting no OCSD, although the difference was not significant (p-GEE=.09). CONCLUSION The results are consistent with the hypothesis that a familial relationship exists between OCSD and RF, since an OCSD in the RF proband was found to increase the risk of OCSDs among FDRs. Additional neuroimmunological and genetic studies involving larger samples are needed to further elucidate this apparent familial relationship between RF and OCSD.
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Affiliation(s)
- Ana Gabriela Hounie
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
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Ramasawmy R, Faé KC, Spina G, Victora GD, Tanaka AC, Palácios SA, Hounie AG, Miguel EC, Oshiro SE, Goldberg AC, Kalil J, Guilherme L. Association of polymorphisms within the promoter region of the tumor necrosis factor-alpha with clinical outcomes of rheumatic fever. Mol Immunol 2006; 44:1873-8. [PMID: 17079017 DOI: 10.1016/j.molimm.2006.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 09/28/2006] [Accepted: 10/02/2006] [Indexed: 11/25/2022]
Abstract
Rheumatic fever (RF)/rheumatic heart disease (RHD) is an inflammatory disease with a complex etiology in which Group A streptococci within a genetically susceptible host untreated for strep-throat may deviate the innate and adaptive arms of the immune system towards recognition of autoantigens. The TNFA gene has been associated with a number of autoimmune diseases, including RF. We investigated whether the G-308A and G-238A polymorphisms of the TNFA gene are associated with clinical outcomes of RF in a cohort of 318 patients and 281 healthy controls (HC). Both polymorphisms showed borderline associations with RF (TNFA -308G/A, OR=1.4 [1-2.2], P=0.026; TNFA -238G/A, OR=1.9 [1-3.3], P=0.015). The presence of either one of the minor alleles (-308A and -238A) was more common among patients with RF/RHD than controls (P=0.0006). Stratification of patients according to clinical phenotype also showed significant associations between presence of either one of the minor alleles and RHD (Pc=0.0006) when compared with controls. This association was stronger with the development of aortic valve lesions. In contrast, there was no association between genotype and Sydenham's chorea or RF patients with mild carditis. In conclusion, we show that the TNFA is a susceptibility locus for RF. The ability to predict which RF patients will develop valve lesion may have therapeutic, economic and social implications.
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48
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Guilherme L, Faé KC, Oshiro SE, Tanaka AC, Pomerantzeff PMA, Kalil J. Rheumatic fever: how S. pyogenes-primed peripheral T cells trigger heart valve lesions. Ann N Y Acad Sci 2006; 1051:132-40. [PMID: 16126952 DOI: 10.1196/annals.1361.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/12/2022]
Abstract
The pathogenesis of rheumatic fever (RF) is related to autoimmune humoral and cellular responses against human tissues triggered by Streptococcus pyogenes. CD4(+) T cells are the ultimate effectors of chronic heart lesions in rheumatic heart disease (RHD). Heart-infiltrating CD4(+) T cell clones are able to recognize heart tissue and streptococcal antigens by molecular mimicry. The streptococcal M5(81-103) region, an immunodominant region, was recognized by both intralesional and peripheral T cell clones (62% and 38%, respectively). Peripheral T lymphocytes from Brazilian patients with severe RHD preferentially recognized the M5(81-96) peptide, in the context of HLA-DR7(+) and DR53(+) molecules. HLA-DR7 seems to be related to the development of multiple valvular lesions in RHD patients from different countries. In addition, the fact that peripheral and intralesional T cells recognized the M5(81-103) region points to this region as one of the streptococcal triggers of autoimmune reactions in RHD. T cell repertoire analysis from peripheral and intralesional T cell lines derived from RHD patients showed several oligoclonal expansions of BV families. Major expansions were found in the heart lesions, suggesting that such T cell populations preferentially migrate from the periphery to the heart. Some cross-reactive intralesional T cell clones displayed the same T cell receptor (TCR) BVBJ and CDR3 sequences, showing a degenerate pattern of antigen recognition. Heart tissue-infiltrating cells from myocardium and valvular tissue produced TNF-alpha, IFN-gamma, IL-10, and IL-4, whereas few cells from valvular tissue produced IL-4, showing that the lack of regulation in the valves could be responsible for the permanent and progressive valvular lesions.
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Affiliation(s)
- L Guilherme
- Laboratório de Imunologia, Instituto do Coração (HC-FMUSP), School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 44-9 andar., 05403-000 São Paulo, SP, Brazil.
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49
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Faé KC, da Silva DD, Oshiro SE, Tanaka AC, Pomerantzeff PMA, Douay C, Charron D, Toubert A, Cunningham MW, Kalil J, Guilherme L. Mimicry in recognition of cardiac myosin peptides by heart-intralesional T cell clones from rheumatic heart disease. J Immunol 2006; 176:5662-70. [PMID: 16622036 DOI: 10.4049/jimmunol.176.9.5662] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Molecular mimicry between Streptococcus pyogenes Ags and human proteins has been considered as a mechanism leading to autoimmune reactions in rheumatic fever and rheumatic heart disease (RHD). Cardiac myosin has been shown as a putative autoantigen recognized by autoantibodies of rheumatic fever patients. We assessed the human heart-intralesional T cell response against human light meromyosin (LMM) and streptococcal M5 peptides and mitral-valve-derived proteins by proliferation assay. Cytokines induced by LMM peptides were also evaluated. The frequency of intralesional T cell clones that recognized LMM peptides was 63.2%. Thirty-four percent of T cell clones presented cross-reactivity with different patterns: 1) myosin and valve-derived proteins; 2) myosin and streptococcal M5 peptides; and 3) myosin, valve-derived proteins and M5 peptides. In addition, several LMM peptides were recognized simultaneously showing a multiple reactivity pattern of heart-infiltrating T cells. Inflammatory cytokines (IFN-gamma and TNF-alpha) were predominantly produced by heart-infiltrating T cells upon stimulation with LMM peptides. The alignment of LMM and streptococcal M5 peptides showed frequent homology among conserved amino acid substitutions. This is the first study showing the cellular response by human heart-infiltrating T cells against cardiac myosin epitopes in RHD patients. The high percentage of reactivity against cardiac myosin strengthens its role as one of the major autoantigens involved in rheumatic heart lesions. T cell reactivity toward myosin epitopes in RHD patients may also trigger the broad recognition of valvular proteins with structural or functional similarities.
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Affiliation(s)
- Kellen C Faé
- Heart Institute (Instituto do Coração) University of São Paulo, School of Medicine, Avenida Dr. Eneas de Carvalho Aguiar, 44-9o andar, 05403-000 São Paulo, Brazil
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50
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Blank M, Krause I, Magrini L, Spina G, Kalil J, Jacobsen S, Thiesen HJ, Cunningham MW, Guilherme L, Shoenfeld Y. Overlapping humoral autoimmunity links rheumatic fever and the antiphospholipid syndrome. Rheumatology (Oxford) 2006; 45:833-41. [PMID: 16705050 DOI: 10.1093/rheumatology/kel118] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [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: 12/17/2022] Open
Abstract
OBJECTIVE Rheumatic fever (RF) and the antiphospholipid syndrome (APS) are autoimmune diseases that share similar cardiac and neurological pathologies. We assessed the presence of shared epitopes between M protein, N-acetyl-beta-D-glucosamine (GlcNAc) and beta2 glycoprotein-I (beta2GPI), the pathogenic molecules engaged in these autoimmune conditions. METHODS Sera from the APS patients were affinity-purified on beta2GPI and beta2GPI-related peptide columns. Sera from RF patients were affinity-purified on protein G column. The beta2GPI and M protein-related peptides were prepared by conventional solid-phase peptide synthesis. The enzyme-linked immunosorbent assay direct binding and inhibition studies were performed on the RF and APS sera for the presence, and cross-reactivity, of antibodies against beta2GPI, beta2GPI-related peptides, streptococcal M protein, M-derived peptides and GlcNAc. RESULTS Antibodies (Abs) to beta2GPI were found in 24.4% of 90 RF patients. Antibodies against various beta2GPI-related peptides were found in 1.1-36.7% of the patients. The immunoglobulin G sera from RF patients possessed significant anti-beta2GPI activity, while sera from APS patients contained a considerable anti-streptococcal M protein as well as anti-GlcNAc activity. Furthermore, affinity-purified anti-beta2GPI and anti-beta2GPI-related peptide Abs from APS patients cross-reacted with streptococcal M protein and M5 peptide, while beta2GPI and beta2GPI-related peptides inhibited anti-streptococcal M protein activity from RF patients. The results were confirmed by immunoblot analyses. The beta2GPI also inhibited anti-GlcNAc activity from APS patients with chorea. CONCLUSIONS The results of our study, showing a considerable overlap of humoral immunity in RF and APS, support a hypothesis that common pathogenic mechanisms underlie the development of cardiac valve lesions and Central Nervous System abnormalities in both diseases.
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Affiliation(s)
- M Blank
- Research Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 52621, Israel
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