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Cytokine Gene Expression In Rheumatic Fever.

1M Hafez, 1Z EL-Morsy, 3F EL-Shennawy, 4S Hawas, 2A Sheishaa, 2H AL-Marsafawy, 2M Abo-EL-Kheir, 1M Shokeir, 1T EL-Desoky, 5B EL-Deek, 1G Atia and 1G EL-Bakary.

1Pediatric Genetics and 2Cardiology Units, Department of Pediatrics, Immunology Divisions, Departments of 3Clinical Pathology and 4Microbiology, 5Biostatistic Division, Department of Community Medicine, Faculty of Medicine, Mansoura University, Egypt.

Gene expression of the cytokines; IL-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IFNg, TNFa in rheumatic fever. The study included 146 children divided into the following groups (G): G1: 29 with active rheumatic heart disease (ARHD); G2: 8 with active rheumatic fever arthritis (ARFA); G3: 6 with active rheumatic heart disease and arthritis (ARHDA); G4: 36 with inactive rheumatic heart disease (IARHD); G5: 5 with inactive rheumatic fever and arthritis (IARFA); G6: 5 with inactive rheumatic heart disease and arthritis (IARHDA); G7: 7 normal children with streptococcal pharynigitis, G8: 50 healthy children with age and sex matched as control. All of them were subjected to the following: (1) clinical examination and laboratory investigations including complete blood picture, throat culture, (ASO), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), electrocardiography (ECG), Echocardiography, (2) measurement of mRNA and serum levels of IL-1a, IL-1b, IL-2, Il-4, IL-6, IL-8, IL-10, IL-12, IFN-g and TNF-a. All investigations were repeated after treatment only for patients with ARHD and ARFA. Serum levels of all cytokines were parallel to mRNA expression levels. In ARHD, the highest level was for IL-1a followed by IL-2 and TNFa (P< 0.001). In ARFA, IL-6 was the most significantly (P< 0.001) produced cytokine followed by IL-10. In IARHD, levels of IL-1a and IL-2 were significantly higher than control. No significant differences were found between the levels of all cytokines in children with streptococcal pharyngitis and controls. It is concluded that estimation of IL-1a in carditis and IL-6 in arthritis may be helpful as minor criteria for diagnosis and follow up of rheumatic activity. Future therapy of rheumatic carditis with anti IL-1a, IL-2 and TNFa immediately after diagnosis is recommended to prevent or reduce valvular damage.