Rheumatic fever: the T cell response leading to autoimmune aggression in the heart

Molecular mimicry between streptococcal and heart components has been proposed as the triggering factor leading to autoimmunity in rheumatic heart disease (RHD). CD4+ T cells apparently are the ultimate effectors of chronic heart lesions. In this review we summarize the studies on the T cell response of peripheral blood mononuclear cells and T cell clones infiltrating heart lesions from RHD patients against streptococcal M protein peptides and human heart tissue proteins. The T cell receptor usage and the cytokine profile of intralesional mononuclear cells are also presented.