Post-infectious group A streptococcal autoimmune syndromes and the heart

W.J. Martin, A.C. Steer, P.R. Smeesters, J. Keeble, M. Inouye, Jonathan Carapetis, I.P. Wicks

Research output: Contribution to journalReview article

45 Citations (Scopus)
1227 Downloads (Pure)

Abstract

There is a pressing need to reduce the high global disease burden of rheumatic heart disease (RHD) and its harbinger, acute rheumatic fever (ARF). ARF is a classical example of an autoimmune syndrome and is of particular immunological interest because it follows a known antecedent infection with group A streptococcus (GAS). However, the poorly understood immunopathology of these post-infectious diseases means that, compared to much progress in other immune-mediated diseases, we still lack useful biomarkers, new therapies or an effective vaccine in ARF and RHD. Here, we summarise recent literature on the complex interaction between GAS and the human host that culminates in ARF and the subsequent development of RHD. We contrast ARF with other post-infectious streptococcal immune syndromes - post-streptococcal glomerulonephritis (PSGN) and the still controversial paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), in order to highlight the potential significance of variations in the host immune response to GAS. We discuss a model for the pathogenesis of ARF and RHD in terms of current immunological concepts and the potential for application of in depth "omics" technologies to these ancient scourges.
Original languageEnglish
Pages (from-to)710-725
JournalAutoimmunity Reviews
Volume14
Issue number8
Early online date17 Apr 2015
DOIs
Publication statusPublished - Aug 2015

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