Group G Streptococcus Induces an Autoimmune Carditis Mediated by Interleukin 17A and Interferon γ in the Lewis Rat Model of Rheumatic Heart Disease

J Infect Dis. 2018 Jun 20;218(2):324-335. doi: 10.1093/infdis/jix637.

Abstract

Acute rheumatic fever and rheumatic heart disease (ARF/RHD) have long been described as autoimmune sequelae of Streptococcus pyogenes or group A streptococcal (GAS) infection. Both antibody and T-cell responses against immunodominant GAS virulence factors, including M protein, cross-react with host tissue proteins, triggering an inflammatory response leading to permanent heart damage. However, in some ARF/RHD-endemic regions, throat carriage of GAS is low. Because Streptococcus dysgalactiae subspecies equisimilis organisms, also known as β-hemolytic group C streptococci and group G streptococci (GGS), also express M protein, we postulated that streptococci other than GAS may have the potential to initiate or exacerbate ARF/RHD. Using a model initially developed to investigate the uniquely human disease of ARF/RHD, we have discovered that GGS causes interleukin 17A/interferon γ-induced myocarditis and valvulitis, hallmarks of ARF/RHD. Remarkably the histological, immunological, and functional changes in the hearts of rats exposed to GGS are identical to those exposed to GAS. Furthermore, antibody cross-reactivity to cardiac myosin was comparable in both GGS- and GAS-exposed animals, providing additional evidence that GGS can induce and/or exacerbate ARF/RHD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antigens, Bacterial / immunology
  • Autoimmune Diseases / etiology*
  • Autoimmune Diseases / microbiology
  • Autoimmune Diseases / physiopathology
  • Bacterial Outer Membrane Proteins / immunology
  • Carrier Proteins / immunology
  • Disease Models, Animal
  • Female
  • Heart Valve Diseases / etiology
  • Heart Valve Diseases / microbiology
  • Heart Valve Diseases / physiopathology
  • Interferon-gamma / metabolism*
  • Interleukin-17 / metabolism*
  • Myocarditis / etiology
  • Myocarditis / microbiology
  • Myocarditis / physiopathology
  • Rats, Inbred Lew
  • Rheumatic Heart Disease / etiology*
  • Rheumatic Heart Disease / microbiology
  • Rheumatic Heart Disease / physiopathology
  • Streptococcal Infections / pathology*
  • Streptococcus / immunology*
  • Streptococcus / pathogenicity

Substances

  • Antigens, Bacterial
  • Bacterial Outer Membrane Proteins
  • Carrier Proteins
  • IL17A protein, human
  • Il17a protein, rat
  • Interleukin-17
  • streptococcal M protein
  • Interferon-gamma