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Published on: June 23, 2014
Anti-endothelial cell antibodies in rheumatic heart disease
V Scalzi1, H Abu Hadi, C Alessandri
1Dipartimento di Clinica e Terapia Medica, Sapienza Università di Roma, Roma, Italy.
Insights
Yemeni rheumatic heart disease (RHD) patients show higher anti-endothelial cell antibodies (AECA) and lower mannose-binding lectin (MBL) levels. AECA correlate with disease severity, suggesting a role in RHD pathogenesis.
Area of Science:
- Immunology
- Cardiology
- Rheumatology
Background:
- Rheumatic heart disease (RHD) is a significant cause of valvular damage worldwide.
- The immunological underpinnings of RHD pathogenesis require further elucidation.
- Autoantibodies and complement factors may play a role in the progression of RHD.
Purpose of the Study:
- To investigate the prevalence of anti-endothelial cell antibodies (AECA), anti-cardiolipin antibodies (aCL), and serum mannose-binding lectin (MBL) in Yemeni RHD patients.
- To correlate these immunological markers with clinical and echocardiographic features of RHD.
- To explore the potential pathogenic role of AECA in RHD.
Main Methods:
- A cohort of 140 Yemeni RHD patients and 140 healthy controls were recruited.
- Serum levels of AECA, aCL, and MBL were quantified using solid-phase enzyme-linked immunosorbent assays (ELISAs).
- Echocardiography was performed to assess RHD severity, including aortic stenosis.
Main Results:
- Forty percent of RHD patients were positive for AECA, while only 7.8% were positive for aCL.
- Serum MBL levels were significantly lower in RHD patients compared to healthy controls (median 4221 ng/ml vs. 5166 ng/ml).
- AECA titres showed a positive correlation with patient age, RHD duration, and aortic stenosis severity.
Conclusions:
- AECA may be involved in the pathogenesis of RHD, potentially linking endothelial activation to valvular damage.
- Lower MBL levels in RHD patients suggest a possible role for complement dysregulation.
- These findings highlight the potential of AECA as biomarkers and therapeutic targets in RHD.
Abstract:
To evaluate the anti-endothelial cell antibodies (AECA), anti-cardiolipin antibodies (aCL) and serum mannose-binding lectin (MBL) profiles of a large cohort of Yemeni patients with rheumatic heart disease (RHD) and to correlate these findings with clinical features of the disease. Patients (n = 140) were recruited from Al-Thawra Hospital in Sana'a, Yemen. All had RHD diagnosed according to modified Jones' criteria. We also studied 140 sex- and age-matched healthy blood donors from the same area. Echocardiography was performed according to the recommendations of the American Society of Echocardiography. Solid phase enzyme-linked immunosorbent assays (ELISAs) were used to measure AECA and aCL titres and serum MBL levels. Forty per cent of the patients were AECA-positive, but only 7·8% were positive for aCL antibodies. Serum MBL levels were significantly lower in the RHD group (median 4221 ng/ml versus 5166 ng/ml in healthy controls). AECA titres were correlated positively with patient age, duration of RHD and the severity of aortic stenosis, as determined by echocardiographic findings. In several autoimmune rheumatic diseases, such as systemic lupus erythematosus, vasculitis and scleroderma, AECA have been shown to play pathogenic roles by producing proinflammatory and procoagulant effects (increased expression of adhesion molecules and tissue factors, increased cytokine release) in endothelial cells. In RHD, these autoantibodies might represent a pathological link between activation of the valvular endothelium and valvular damage.
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