만성 루마치스성 심장병 환자의 승모판에서 TGF-1의 발현

초록

Rheumatic fever is the consequence of a pharyngeal infection with group A streptococcus in a susceptible host, leading to an immune-mediated systemic disease. The most important sequelae of rheumatic fever is chronic rheumatic heart disease, characterized by deforming fibrotic valvular disease, which can produce permanent and severe cardiac dysfunction decades later. But the mechanism involved in this delayed valvular destruction has not yet been evaluated. In this study, we investigated the expression of transforming growth factor-1 (TGF-1) using immunohistochemistry and reverse transcription-polymerase chain reaction. We also evaluated the relationship between TGF-1 expression and valvular fibrosis and the change of extracellular matrix components in 30 mitral valves of chronic rheumatic heart disease and 15 normal control valves. In chronic rheumatic heart disease, mitral valves showed higher TGF-1 expression compared with control valves and higher TGF-1 expression correlated with valvular fibrosis, inflammatory cell infiltration, neovascularization and calcification. Proteoglycan deposition and ratio of proteoglycan to collagen deposition were inversely correlated with TGF-1 expression in mitral valves. Rheumatic mitral valves showed increased TGF-1 mRNA expression compared with control valves, and TGF-1 mRNA expression showed positive correlation with TGF-1 expression on immunohistochemical staining but these findings were statistically insignificant. In conclusion, an ongoing inflammatory process within the valves and compensatory expression of TGF-1 might be related to the fibrosis, calcification, and change of extracellular matrix leading to the scarring sequelae typical of rheumatic heart disease.