Streptococcus mutans and the problem of heart cross-reactivity

Investigations of immune responses to Streptococcus mutans have fostered consideration of vaccination as a possible preventive measure against dental caries. However, the finding that hyperimmune rabbit antisera to S. mutans sometimes give immunofluorescent reactions on human heart raised concerns over safety, especially as most individuals display circulating antibodies to this common oral organism. Recent progress in elucidating the molecular mechanisms of the well-established immunological cross-reactivity between group A streptococci and human heart tissue and the structure of S. mutans antigens permits a re-evaluation of this problem. This review examines the evidence for heart cross-reactivity induced by S. mutans in relation to studies on group A streptococci and current understanding of autoimmunity. Although the mechanisms involved in this phenomenon need further clarification, it now appears that it cannot be ascribed to antigenic similarity between heart tissue and a high-molecular-weight surface protein antigen of S. mutans.