Abstract
BackgroundRheumatic heart disease is an autoimmune disease caused by group A streptococci infection and frequently affects the aortic valve. Sex differences are common in the disease progression, treatment, and outcome. However, little is known about the sex differences in the pathology of aortic valves in rheumatic heart disease.DesignWe studied the end-stage calcific aortic valves from male versus female patients to reveal the sex-dependent pathology differences and molecular changes associated with requiring valve replacement.MethodsAortic valves from 39 patients with rheumatic heart disease (19 males and 20 females) were collected at the time of aortic valve replacement for comparative pathology, immunohistochemistry, and gene expression analyses. Clinical characteristics were also analyzed and compared between the two groups.ResultsAortic valves from female patients exhibited increased expression of collagens, infiltration of monocytes/macrophages and neovascularization. Aortic valves from female patients also had increased expression of inflammatory genes involved in the NFKB pathway (phosphorylated NFKB p65 subunit, IL8, and NOS3) and Th1 cytokine genes (IFNA and IL12B). The severe valve pathology in female patients was correlated with a higher serum level of anti-streptolysin O antibodies.ConclusionInflammation is more prominent in aortic valves of female patients with rheumatic heart disease. This sex difference may contribute to the severe valve pathology and worse outcome of female patients.
Highlights
Rheumatic heart disease (RHD) causes 1.4 million deaths per year in developing countries[1, 2]
This sex difference may contribute to the severe valve pathology and worse outcome of female patients
Since streptococcal infection is a major pathogenesis of RHD[4, 11], we evaluated the serum level of rheumatoid factor (RF), anti-streptolysin O (ASO) and C-reactive protein (CRP) between the two groups
Summary
Rheumatic heart disease (RHD) causes 1.4 million deaths per year in developing countries[1, 2]. The disease starts with group A streptococci infection. RHD patients have a high prevalence of severe cardiovascular complications, including rheumatic carditis, atrial fibrillation, pulmonary hypertension, and congestive heart failure. The most serious complication is rheumatic carditis, which often affects the mitral and aortic valve[3,4,5]. The essence of RHD is cardiac valve inflammation[1, 5, 6]. Rheumatic heart disease is an autoimmune disease caused by group A streptococci infection and frequently affects the aortic valve. Sex differences are common in the disease progression, treatment, and outcome. Little is known about the sex differences in the pathology of aortic valves in rheumatic heart disease
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