Rheumatic Heart Disease and Myxomatous Degeneration: Differences and Similarities of Valve Damage Resulting from Autoimmune Reactions and Matrix Disorganization

PLoS One. 2017 Jan 25;12(1):e0170191. doi: 10.1371/journal.pone.0170191. eCollection 2017.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / metabolism
  • Autoimmune Diseases / pathology*
  • Collagen Type VI / analysis
  • Extracellular Matrix / chemistry
  • Female
  • Gene Expression Profiling
  • Humans
  • Lumican / analysis
  • Male
  • Middle Aged
  • Mitral Valve / chemistry
  • Mitral Valve Prolapse / etiology
  • Mitral Valve Prolapse / immunology
  • Mitral Valve Prolapse / metabolism
  • Mitral Valve Prolapse / pathology*
  • Protein Domains
  • Proteomics
  • Rheumatic Heart Disease / immunology
  • Rheumatic Heart Disease / metabolism
  • Rheumatic Heart Disease / pathology*
  • Vimentin / analysis
  • Vitronectin / analysis

Substances

  • Collagen Type VI
  • LUM protein, human
  • Lumican
  • Vimentin
  • Vitronectin

Grants and funding

Committee for the improvement of post-graduation students (CAPES); Immunology Investigation Institute (iii) from National Institute for Science and Technology (INCT) through FAPESP—Fundação de Amparo à Pesquisa do Estado de São Paulo—2008/573879 and CNPQ—ConselhoNacional de PesquisaCNPq 2008/57881-0. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.