Abstract
Problem statement: The primary aim was to study the expression of CD44 protein in the heart valves removed surgically for either stenosis or regurgitation and to study the morphology of valves using histochemical staining. Approach: We studied 107 valves which were collected from the International Centre for Cardio Thoracic and Vascular Diseases. Results: Aortic and mitral valves were obtained from the centre and processed in research pathology lab. CD44 protein is a receptor for the ligand hyaluronic acid which causes inflammation in the heart valves. A total of 107 valves were studied. Of the 61 mitral valves studied 38 (62.2%) showed CD44 positivity as brownish granules within the cytoplasm. Of the 46 aortic valves studied 19 (41.3%) showed CD44 positivity as brownish granules within the cytoplasm. The valves showed evidence of past inflammation showing thick and thin walled blood vessels and lymphocytes. CD44 protein increased in 62.2% of mitral valves, of which 60.5% were from patients presenting when they were less than 40 years old. CD44 protein increased in 41.3% of aortic valves, of which 63.15% were from patients presenting when they were less than 40 years old. CD44 positivity was seen in 57 valves as brownish granules within the cytoplasm of the cell. CD44 protein increased in 53.27% of mitral and aortic valves, of which 63.15% were from the males patients. CD44 protein increased in 53.27% of mitral and aortic valves, of which 36.84% were from the females patients. Conclusion/Recommendations: The results showed CD44 is over expressed in the heart valves removed surgically for stenosis or regurgitation where the hyaluronic acid content is high.
Highlights
Rheumatic fever and its cardiac sequelae continue to be an enigma as to why some people are predisposed to cardiac involvement while others are not
CD44 protein increased in 41.3% of aortic valves, of which 63.15% were from patients
CD44 protein increased in 53.27% of mitral removed for either incompetence or stenosis secondary and aortic valves, of which 36.84% were from the to rheumatic heart disease had an increased expression females patients (Table 3)
Summary
Rheumatic fever and its cardiac sequelae continue to be an enigma as to why some people are predisposed to cardiac involvement while others are not. That is due in predisposed patients to an autoimmune reaction to untreated or partially treated group A streptococcal pharyngitis has been established. The component of the bacteria responsible for the antigen cross reactivity to the heart tissue has not been established. Cross reactivity was initially observed in extracts of the streptococcal cell wall. The M protein has been the most extensively studied component of the streptococcus (Fischetti, 1991). The streptococcal cell wall has a high concentration of N-acetyl-glucosamine, which is found in high concentrations in valvar tissue (Veasy and Hill, 1997). The group a streptococcus capsule is composed of hyaluronic acid, which is increased in valves (Marcon et al, 1988). As CD44 protein is a common component we hypothesized that this may be responsible for the cross reactivity
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